Name of the Procedure:

Avulsion of Nail Plate, Partial or Complete, Simple; Each Additional Nail Plate (Performed as an adjunct to a primary procedure)

Summary

Nail avulsion involves the removal of part or all of a nail plate. This procedure can be carried out on additional nails beyond the primary one affected, allowing treatment of multiple nails during the same session.

Purpose

This procedure addresses conditions like severe nail fungal infections, ingrown nails, or trauma to the nail. The goal is to alleviate pain, resolve infection, or enable further treatments such as direct medication application to the nail bed.

Indications

• Severe fungal nail infections
• Painful or recurrent ingrown toenails
• Traumatic nail injury
• Nail bed lacerations or infections
• Need for biopsy of the nail matrix or bed

Preparation

• No specific fasting is usually required.
• Patients might be advised to stop certain medications (like blood thinners) before the procedure.
• Any allergies or existing medical conditions should be communicated to the healthcare provider.
• Pre-procedure assessment may include a physical inspection of the nails.

Procedure Description

1. Anesthesia: Local anesthesia is administered to numb the affected finger or toe.
2. Nail Removal: A sterile instrument separates the nail plate from the nail bed.
   • Partial Avulsion: Only the affected part of the nail is removed.
   • Complete Avulsion: The entire nail plate is removed.
3. Dressing: The exposed nail bed is covered with an antibiotic ointment and a sterile dressing to protect it and promote healing.

Duration

The procedure typically takes about 15 to 30 minutes per nail.

Setting

Performed in a clinical setting such as an outpatient clinic or a doctor's office.

Personnel

• Physician or specialist (e.g., a podiatrist or dermatologist)
• Nurse or medical assistant for support

Risks and Complications

• Infection at the removal site
• Bleeding
• Pain and swelling
• Delayed nail regrowth or changes in nail appearance
• Rarely, damage to the nail matrix resulting in permanent nail loss

Benefits

• Relief from pain and infection
• Improved nail appearance and function
• Facilitates direct treatment of the nail bed or underlying condition

Recovery

• Keep the area clean and dry.
• Follow specific wound care instructions provided by the healthcare provider.
• Over-the-counter pain relievers can manage pain.
• Return to normal activities once cleared by the physician, usually within a few days to a week.
• Follow-up appointment for assessment and any further treatment.

Alternatives

• Antifungal medications for nail infections
• Conservative treatments for ingrown nails, like soaks and proper trimming
• Nail debridement (trimming dead or infected parts without full removal)
• Cryotherapy or chemical treatments for nail-related conditions

Patient Experience

Patients might feel a brief sting from the anesthesia followed by pressure or pulling sensations. Post-procedure discomfort is manageable with prescribed pain relief methods. Recovery includes care of the wound site and gradual return to daily activities.