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Nail Surgery

Nail surgery is a medical treatment for certain nail conditions that cause pain and/or discomfort. When more conservative treatment measures do not suffice, or if your condition affects your mobility and ability to function, nail surgery may be recommended to provide relief, restore healthy nail growth and prevent future complications.

What is Nail Surgery?

Nail surgery, also known as nail avulsion or nail removal surgery, refers to surgical procedures that address nail issues and conditions, from benign conditions, such as ingrown nails and damaged nail beds, to more serious ones like nail tumours.

These procedures are generally minimally invasive and can involve removing parts of the nail, or tissues surrounding the nail, and done under local anaesthesia. Most times, the affected nail can grow back normally. However, when treating chronic or serious nail conditions, it is important to set realistic expectations and understand risks on recovery and regrowth of the nail, some procedures may result in total loss of the nail.

What can nail surgery treat?

Nail surgery is generally recommended when you experience:

Painful ingrown nails — Ingrown nails happen when the sides of the nails grow inwards into the flesh, causing pain, inflammation, and sometimes infections. This is the most common indication of nail surgeries.
Chronic or recurrent fungal infections — Nail infections are also known as onychomycosis, these are usually caused by tinea pedis, the fungus that causes athlete’s foot. Symptoms are usually discolouration of the nail, distortion of nail shape, pain and discomfort, and brittle nails that break easily. Fungal infections that keep coming back may require nail surgery to debride or remove the infected nail.
Abnormal growth of nails, such as malalignment — Abnormal nail growths or structures, and nails that grow out of alignment can injure the surrounding skin and lead to further complications such as inflammation or infection.
Nail tumours [2] — Nail tumours are usually concealed under the nail plate and require nail surgery for removal. Nail tumours can be benign such as onychomatricoma and glomus tumours, or malignant such as squamous cell carcinomas or melanomas.

In some cases, such as with tumours, a nail biopsy is often performed prior to the nail surgery. This is a diagnostic step to identify the nature of the growth. Misdiagnosis and removal of malignant tumours may cause it to come back or become more aggressive and hence life threatening. Reach out to us if you have any concerns of any nail abnormalities that necessitate a biopsy or diagnosis.

Common types of nail surgery:

Partial nail avulsion — Partial nail plate avulsion refers to removal or lifting part of the nail, just enough to reach the area of concern underneath the nail plate. This can be applied to relatively minor conditions that do not affect the whole nail, such as fungal infections or ingrown nails.
Total nail avulsion — In a total nail avulsion procedure, the entire nail is removed. This can be done to expose concealed tumours [5], or remove severe ingrown nails. Normal growth of the nail will consequently take a longer time due to total removal.
Matricectomy — Matricectomy refers to the destruction of the nail matrix, often using phenol. This procedure will result in permanent nail loss [1,3]. Matricectomy can be used to remove part or all of the nail matrix. Matricectomy is usually indicated for onychauxis (thickened nails), onychogryphosis (abnormal thickening and curving of the nail), or recalcitrant ingrown nails [3].

Treating serious or chronic nail conditions may necessitate extreme measures. Your dermatologist should inform you on what to expect for the surgical treatment. It is important that you understand the side effects of certain nail procedures such as nail loss.

What can I expect from a nail surgery?

The general process of a nail surgery is as follows:

Pre-surgery

Consultation — A consultation session is important for our dermatologist to assess and examine your nail condition. If necessary, you may be required to undergo a nail biopsy prior to the treatment to have a thorough diagnosis of your condition. Furthermore, our dermatologist will also go over the recommended surgical procedure and what to expect from the surgery.

During your procedure

Preparation — The area of concern will be thoroughly cleaned and prepped for the surgery.
Anaesthesia — Local anaesthesia will be administered to minimise pain and discomfort throughout the procedure.
Surgical Procedure — Our dermatologist will perform the necessary surgical intervention, this may include nail removal or correction.

Post-surgery

Post-Operative Care — Our dermatology team will provide you with detailed instructions for aftercare and follow-up appointments. This is important to minimise risks of post-operative complications and ensure optimal healing.
Expected recovery timeline — Recovery will depend on the type of surgery you had but most patients should expect a few weeks of downtime for the affected nail.

Post-surgery aftercare for nail health

It is not advisable to drive yourself home after a surgery to avoid unnecessary trauma to your nails, whether finger or toe nail. Once home, the following instructions are highly recommended for optimal healing [4]:

Elevate the limb for 48 hours to alleviate pain and improve healing.
Painkillers can be used for the first 3 days post-surgery, paracetamol is sufficient but non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are more efficient.
Bleeding is normal, and the wound dressing will soak up the bleeding. It is recommended to change the dressing after 24 to 48 hours.
The wound should be cleaned with the antiseptic provided twice a day.
During healing, it is advised to keep the wound plastered to avoid injuries or infections.
Follow-up visits may be necessary for your dermatologist to monitor your condition and ensure proper wound healing.

Are there any risks associated with nail surgery?

As with any surgical intervention, risks are still present in nail surgeries. It is important that you understand the risks of nail surgeries and have a realistic expectation on the final results post operation. The most common risks include:

Infections — Infections may occur during the post-operative healing period, alert your dermatologist if you suspect an infection.
Pain — Normally, some degree of pain and soreness is acceptable after your surgery. It should subside within a few days and can be alleviated with painkillers. Alert your doctor if pain persists or worsens after 24 or 48 hours.
Scarring — Some surgical procedures may lead to scarring depending on the part of the nail operated on [1].
Nail dystrophy — Some conditions and procedures may lead to abnormal growth of the nails [1], such thinning of the nail or a different nail appearance.

However, these risks can be significantly reduced by proper techniques and post-operative wound care. It is important to communicate your doubt and concerns with your doctor as you recover from your surgery.

At Livingstone Dermatology, we are dedicated to providing personalised care for nail conditions. Schedule an appointment with us today for a comprehensive diagnosis and personalised treatment plan.

Frequently Asked Questions

Can I shower after nail surgery?

Yes, peptides and growth factor serums can be layered with other skin care ingredients such as retinols. Using these ingredients together may also enhance the anti-ageing effects. However, it is best to consult your dermatologist before mixing your skin care to ensure optimal results.

Will my nail grow back after nail surgery?

Depending on the type of surgery, your nail can grow back. A total matricectomy will result in permanent nail loss.

How long does it take for the nail to grow back?

If a total nail removal is done, it may take anywhere between 4 to 6 months for it to grow back as long as the nail matrix is intact.

References

Queirós C, Garrido PM, Fraga A, Maia-Silva J, Filipe P. Nail Surgery: General Principles, Fundamental Techniques, and Practical Applications. J Cutan Aesthet Surg. 2022 Oct-Dec;15(4):341-354. doi: 10.4103/JCAS.JCAS_81_21. PMID: 37035605; PMCID: PMC10081470.
Acuña Pinzon CL, Nieves Condoy JF, Rivera Marquez DA, Collazo Moreno ARJ, Cethorth Fonseca RK, Zúñiga Vázquez LA. Nail Cancer: Review of the Two Main Types of an Underestimated Disease. Cureus. 2022 Apr 5;14(4):e23856. doi: 10.7759/cureus.23856. PMID: 35530873; PMCID: PMC9072075.
Baran R, Haneke E. Matricectomy and nail ablation. Hand Clin. 2002 Nov;18(4):693-6, viii; discussion 697. doi: 10.1016/s0749-0712(02)00038-0. PMID: 12516982.
Richert B. Basic nail surgery. Dermatol Clin. 2006 Jul;24(3):313-22. doi: 10.1016/j.det.2006.03.006. PMID: 16798428.
Park YU, Han J, Seo YW. Nail-preserving excision of glomus tumor in the second toe: Case report and literature review. Medicine (Baltimore). 2024 Mar 15;103(11):e37398. doi: 10.1097/MD.0000000000037398. PMID: 38489706; PMCID: PMC10939694.

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