Definition and Overview
Children with nail problems, such as incorrect nail growth or severe infection, can undergo a procedure that removes their nail bed. These conditions are considered to be dermatologic in nature and need to be treated promptly to avoid complications such as extreme pain.
Who Should Undergo and Expected Results
Paediatric nail removal becomes necessary if an existing nail problem can no longer be treated with other means. It is beneficial for paediatric patients, including infants and toddlers, children, adolescents and teenagers, who experience any of the following problems:
Ingrown nail – This is a common condition characterised by a nail that grows into the flesh. It usually affects one corner or one side of the nail.
Deformed nail – Some children may be born with a deformed nail, such as nails that have ridges, pitted nails, or clubbed nails.
Nail bed injury – This affects the tissue between the nail and the bone. This tissue is responsible for securing the nail to the finger or toe and making sure the nail grow normally. This injury is usually a result of getting caught in a door or having the fingers trapped by a heavy object.
Incorrect nail growth – Sometimes, the nail may grow in an incorrect or abnormal manner, such as curling instead of flat and straight.
Infection – There are cases wherein the nails are affected by bacterial, viral, or fungal infection, which can cause symptoms and damage the nails when left untreated.
After a nail removal procedure, the patient is expected to be relieved of any symptoms including:
- Loose nail
- Bruised finger or bruising under the nail
- Nail discoloration or blackening of the nail
- A cut on the nail surface
The procedure treats the nail conditions mentioned above by allowing the nail to grow normally again without the risk of infection.
How the Procedure Works?
Before the procedure, the patient's parent or guardian will be asked to sign a consent form stating that they agree to the treatment. It is the doctor’s responsibility to educate them about the surgery particularly its risks and benefits so they can make the right, informed decision for their child. If they require more information before signing the consent form with confidence and assurance, a brief consultation with the doctor could be scheduled.
A nail removal procedure usually takes an hour and this includes the preparation and administration of anaesthesia. As this is outpatient, the patient will be sent home as soon as the anaesthetic wears off.
Before the procedure begins, the patient will be given local anaesthesia. It is normal to feel some pain as the anaesthesia is injected, so it is best to prepare the child for this part.
Once the anaesthetic takes effect, the doctor will begin the procedure by making a cut from the top going to the cuticle to easily pull the nail off. Since the patient is under the effects of the anaesthesia, this part of the procedure will not be painful, but the patient may feel some pressure as the doctor pulls off the nail. Medications will then be applied to the nail bed so it will heal faster.
After the procedure, a soft dressing will be placed over the affected area to protect it while it heals. Patients are typically prescribed paracetamol for pain that can linger a couple of days after the procedure.
Parents will be sent home with instructions on how to care for their child. Patients, on the other hand, will be advised to wear cotton socks, and to avoid tight shoes and strenuous activities such as running or participating in sports until the toe is fully healed. Full recovery may take between two and four weeks depending on the cause and severity of the problem. After a month, the nail may still look a little lumpy due to some residual swelling, which may take four to six weeks to subside. Within this period, it is normal to see a hard layer of skin growing over the nail bed, which will be replaced by an actual nail in a process that may take anywhere between three and six months.
Possible Risks and Complications
After a paediatric nail removal, patients should watch for signs of an infection, such as:
- Pus or discharge
- Blue or black colour of the toe or entire foot
Like any other procedure, nail removal carries some risks, such as:
- Allergic reaction to anaesthesia
- Severe pain
- Excessive bleeding
- Stiffness of the finger or toe
- Cold intolerance
- Recurrence – The previous problem, such as incorrect nail growth, may occur again as the nail grows again after removal.
- Nail deformity – A new problem, such as a nail that grows with deformities not previously present, may also occur; this is more common if the nail removal procedure was performed due to trauma or injury to the nail bed.
- Complex regional pain syndrome – This is a severe pain reaction accompanied by swelling, stiffness and finger sensitivity and is usually associated with nail bed injuries.
To help prevent any complications, parents and guardians will be given instructions on how to care for the affected area, such as properly replacing the dressing and cleaning the wound. It is also important to show up for a follow-up appointment, which is scheduled around two weeks after the surgery. During the follow-up appointment, the doctor will check on the condition of the nail bed and assess if the wound has healed properly.
Buttaravoli P, Leffler S. Nail bed laceration. In: Buttaravoli P, Leffler SM, eds. Minor Emergencies. 3rd ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 146.
Eckhold J. Nail bed repair. In: Pfenninger JL, ed. Pfenninger and Fowler's Procedures for Primary Care. 3rd ed. Philadelphia, PA: Elsevier Mosby; 2011:chap. 27.