Excision of Nail and Nail Matrix, Partial or Complete (e.g., Ingrown or Deformed Nail), for Permanent Removal; with Amputation of Tuft of Distal Phalanx

Name of the Procedure:

• Common Name: Nail Removal with Finger Tip Amputation
• Medical Term: Excision of nail and nail matrix, partial or complete, with amputation of tuft of distal phalanx

Summary

This procedure involves the surgical removal of part or all of a toenail or fingernail, including the nail matrix, along with the amputation of the tip of the finger or toe. It is typically performed to treat severe nail deformities or ingrown nails that cause pain and infection.

Purpose

• Medical Conditions: Ingrown or severely deformed nails
• Goals:
  • To relieve pain and infection
  • To prevent recurrence of the nail problem
  • To achieve permanent removal of the problematic nail and associated tissue

Indications

• Persistent ingrown nails causing chronic pain and infection
• Severely deformed nails not responding to conservative treatments
• Recurrent nail problems affecting the patient's quality of life

Preparation

• Pre-Procedure Instructions:
  • Fasting for a specific period if general anesthesia is used
  • Stopping certain medications, as advised by the healthcare provider
• Diagnostic Tests: Possibly X-rays or blood tests to assess general health and specific conditions

Procedure Description

1. Anesthesia: Local anesthesia to numb the affected area, or general anesthesia in some cases.
2. Nail Removal:
   • The affected nail is partially or completely removed
   • The nail matrix (growth center of the nail) is excised to prevent regrowth
3. Amputation:
   • The distal tip (tuft) of the phalanx (finger or toe bone) is amputated
   • The wound is then closed with sutures, and a dressing is applied

Duration

Approximately 30 to 60 minutes, depending on the extent of the surgery.

Setting

Performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Surgeon: Performs the procedure
• Nurses: Assist during the procedure and provide post-operative care
• Anesthesiologist: Administers and monitors anesthesia, if required

Risks and Complications

• Common Risks:
  • Infection
  • Bleeding
  • Pain
• Rare Complications:
  • Nerve damage
  • Poor wound healing
  • Recurrence of nail growth

Benefits

• Relief from chronic pain and infection
• Permanent solution to recurrent nail problems
• Improvement in quality of life Expected benefits are usually realized within a few weeks post-surgery.

Recovery

• Post-Procedure Care:
  • Keep the wound clean and dry
  • Follow instructions for dressing changes
  • Take prescribed pain medications and antibiotics
• Recovery Time:
  • Initial recovery in 1-2 weeks
  • Complete healing may take a few months
• Restrictions:
  • Limited use of the affected finger or toe
  • Follow-up appointments to monitor healing

Alternatives

• Other Treatment Options:
  • Conservative treatments like warm soaks, proper nail trimming, antibiotics, and avoiding tight footwear
  • Less invasive procedures like partial nail removal without matrix excision
• Pros and Cons:
  • Alternatives may be less invasive but often have higher recurrence rates.
  • The described procedure offers a more permanent solution but involves more recovery time.

Patient Experience

• During the Procedure: Local anesthesia will prevent pain, but there may be sensations of pressure or movement. If general anesthesia is used, the patient will be unconscious.
• After the Procedure: Post-operative pain managed with medications, possible swelling, and discomfort in the affected area. Pain and discomfort generally diminish within a few days.

Comfort measures include keeping the affected limb elevated and following the healthcare provider’s instructions for wound care.