What is Nail surgery?

There are two types of nail surgery which are commonly carried, out. Partial and Total nail avulsion. In a partial nail avulsion, a slither of nail, around 2-4mm wide, is removed from one or both sides of the nail. The "root" of the nail is then treated with a chemical to prevent that section from growing back. This makes the new nail plate narrower and far less likely to grow in. This is by far the most common intervention, used when the nail is essentially healthy apart from the ingrowing.

A total nail avulsion is when the entire nail is removed, and prevented from regrowing. This is carried out when the entire nail (not just the edges) is badly damaged, infected or malformed.

Is Nail Surgery effective?

Yes, Very. The Cochrane Database, the international database of clinical best practice states that:-

Surgical interventions are more effective than non-surgical interventions in preventing the recurrence of an ingrowing toenail.

The NICE guidelines, the UK set of recommendations, state that

• If bathing the toe and using well-fitting footwear does not result in improvement, the optimal treatment consists of partial avulsion of the nail combined with phenolisation.

Essentially whilst conservative management can sometimes remove the pain and treat the immediate problem, it cannot prevent it from happening again. Therefore if the problem keeps cropping up, Nail surgery offers a safe and effective permanent solution.

First 24 hours

Your Toe will be numb for several hours after nail surgery. However this
does not mean that it is invulnerable! After surgery you should go directly
home and elevate your leg. The quicker and longer you do this, the
less bruising and post operative discomfort you will have. It will also
reduce the chance of post operative bleeding.

It is advisable to take some pain killers before the local anesthetic
wears off. Paracetamol or whatever you would normally take for a
headache is fine, but you should avoid anything containing aspirin, as
this acts as a blood thinner. The chemical we use to cauterize the
nail bed also has a numbing effect on the toe, so post operative pain is
usually mild. You should expect it to feel bruised and sore for a few days,
and during this time it is advisable to avoid wearing any closed in shoe.
Sandals, or slippers with the toe cut out are best.

Sometimes a little blood may spot through the dressing, particularly if you
accidentally knock the toe. If so, just elevate the limb and add a mepore
dressing over the top. If it bleeds heavily, soaking the dressing, contact
the clinic during office hours, or your local minor injuries unit out of hours.
Redressing the Toe After 24 hours, you can do your first dressing change.

You should replace the dressing when it has been on for 24 hours, If the dressing becomes wet, or If the dressing becomes badly fouled by the wound exudate
Continue to dress the toe until such time as the wound has dried out. You’ll
know this has happened when the dressing removed is entirely dry.

How long before I can get back to normal

This depends on you, how bad your toe was, and what normal is to you. However as a rough guide for school children  we would usually expect :-

·        2 Days off school (or equivalent work)

·        2 Weeks off PE (or equivalent sporting activity)

·        2 months before the wound is fully healed and dry

This, however, is only a guide. In perfect circumstances it can be fully healed within 2 weeks. If not well cared for, it can take more than 2 months. However the wounds always heal in the end, and after that, you should never have ingrowing toenails ever again. 

What is involved

Nail surgery is a minor surgical procedure carried out in clinic using local anaesthesia, just like at the dentist. The whole process takes about an hour, however the procedure itself takes less than 10 minutes. The local anaesthetic comes in the form of 2 injections into the base of the toe, which completely numbs this toe. Like any injection, this can be uncomfortable for a few seconds. This, however, is the only discomfort you will experience as the operation itself is completely painless.

After the anesthetic is administered, we allow some time (usually 10-20 minutes) for the toe to go numb. We test very carefully to make sure you are fully numb before we undertake the procedure. We then apply a tourniquet so there is no bleeding during the procedure.

When ready, we make two small parallel cuts straight down the sides of the nail, right to the matrix from which the nail grows. The ingrown sections are then removed, and the matrix treated with the chemical which stops it growing back.

The initial dressing is large, and you will need a sandal or slipper with the toe cut out to accommodate it.

What to expect

Week 1 - Minor / moderate discomfort. Considerable inflammation around the wound, lots of exudate (ooze) from the wound

Weeks 2-4 - Minor Discomfort, decreasing amounts of inflammation and exudate

Weeks 5-8 - increasing scabbing of the wound, exudate decreasing to dryness, discomfort reducing

Weeks 8 – 52 - There will likely be a ridge which grows up the toenail, until the new nail pushes the old one out. May be some very minor inflammation or discomfort until fully grown out

Complications

Nail surgery is generally a safe and straightforward procedure. However as with any minor operation, there can be issues post operatively. You should contact the clinic if you observe:-

·        Inflammation of the whole toe (not just the wound), heavy or malodourous pus, or severe pain