Definition & Overview

Onychectomy is the surgical removal of a part or the whole toenail or fingernail. It is a simple procedure usually performed in a doctor's office or a clinic.

More than their cosmetic purpose, human nails have biologic and physiologic functions. They protect the fingertips and are used for defense or scratching, as well as providing tactile feedback. Nails also play a part in the regulation of peripheral circulation, which distributes blood and collects wastes from all parts of the body.

There are several reasons why doctors perform nail removal. One of the most prevalent is to prevent infection from spreading to other parts of the feet or hands. The procedure can also help ease the constant pain brought about by ingrown nails. In some cases, onychectomy is done to repair a misaligned or abnormally grown nail.

Who Should Undergo and Expected Results

Patients who suffer from ingrown nails are typically offered onychectomy to achieve lasting pain relief. This condition, medically termed onychogryphosis, is quite common and results from the growth of nail inwards or into the nail bed. Patients usually find it painful to walk with this condition. There are also times when there is subsequent inflammation of the nail fold, especially if patients have tried to remove the ingrown nail by themselves in a non-sterile environment.

Surgical nail removal is also recommended for those who have onychogryphosis or "ram's horn", a condition in which the nail thickens and curve into itself as it grows, hence the descriptive name. Often caused by trauma, the nails appear discolored, usually with debris underneath. If left unchecked, this condition may lead to ulceration, laceration, and subsequent infection of the nail bed.

Onychectomy is also performed on patients with fungal infection of the nail. This condition does not only affect the nail but also its matrix and nail bed. Aside from being unsightly, it can also cause pain and disfigurement if it persists over a long period of time.

Patients diagnosed with paronychia can also benefit from having their nails removed. This condition is characterized by an infection of the soft tissue around the fingernail, which appears inflamed, swollen, and tender to touch. The infection may be bacterial or fungal in origin and often leads to abscess, producing pus that needs constant draining.

Onychectomy is a safe, simple procedure that usually lasts for a few minutes. There is high success rate, with patients recovering from their conditions after a short period of rest. They can also resume their daily activities after a few days. This procedure also provides lasting relief and is generally effective in preventing the spread of infection to other parts of the limb. In some cases, the patient is administered with tetanus and diphtheria vaccine to avoid complications later on.

How is the Procedure Performed?

Onychectomy is an outpatient procedure often performed under local anesthesia. With the patient in seated or supine position, the medical staff proceeds to thoroughly clean the affected nail in preparation for the procedure. A tourniquet is also applied to the toe or fingernail to minimize bleeding. For partial nail removal, the surgeon will use a specialized cutting equipment to make a distal cut on the nail. A pair of forceps is then used to grasp the nail and extract it from the rest of its parts. For complete nail removal, a part of the nail is first separated from the nail bed and the surgeon proceeds to remove the affected nail one part at a time until nothing is left. In some cases, the surgeon performs debridement on the exposed tissue following complete nail removal.

To prevent recurrence of nail growth, matricectomy or the total destruction of the nail matrix is also performed. An incision is made in the skin to access the nail matrix hidden underneath the skin. The surgeon has the option of using laser or acid chemical to kill the matrix tissue. The incision is then closed with sutures and the affected area is bandaged.

Possible Risks and Complications

Some patients may show adverse reactions to anesthesia and this is something the medical staff has to watch out for. There are also reports of ischemia following the injection of a higher dose of anesthetic.

Though considered rare, there is also the risk of persistent bleeding. The surgical site can also be infected if bacteria set in.

For partial onychectomy, there is always the possibility of nail regrowth, leading to the recurrence of an ingrown nail. A repeat procedure may be needed to address this complication. Inadvertent injury to the nail matrix and nail bed can also happen.

There are also reports of patients developing epidermal inclusion cyst, which are benign lesions resulting from the implantation of epidermal elements in the skin.

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