The nail is a subject of global importance for dermatologists, podiatrists and surgeons. Nail avulsion is a frequently undertaken, yet simple, intriguing procedure. It may either be surgical or chemical, using 40% urea. The former is most often undertaken using the distal approach. Nail avulsion may either be useful for diagnostic purposes like exploration of the nail bed, nail matrix and the nail folds and before contemplating a biopsy on the nail bed or for therapeutic purposes like onychocryptosis, warts, onychomycosis, chronic paronychia, nail tumors, matricectomy and retronychia. The procedure is carried out mostly under local anesthesia with or without epinephrine (1:2,00,000 dilution). Besides the above-mentioned indications, the contraindications and complications of nail avulsion are briefly outlined.
Nail avulsion surgery is frequently accomplished using a nail elevator device. In addition, a mosquito hemostat or a dental spatula may also be used for the purpose. In distal nail avulsion a-d, the instrument is introduced under the distal free edge of the nail plate so that the nail plate can be separated from the underlying nail bed hyponychium. The nail plate is then separated from the underlying nail bed directed proximally towards the matrix, with significant resistance occurring until the matrix is reached. As the matrix is reached, the surgeon experiences a sudden decrease in resistance. Subsequently, the elevator ] is reinserted with several longitudinal and side to side strokes to detach the nail plate from the nail bed totally. Thereafter, the elevator is inserted under the PNF in the proximal nail groove between the eponychium and the nail plate to release the attachment. This step should be a gentle one so as to avoid inadvertent injury.
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