Successful nail surgery requires exposure of the underlying tissues. In many cases, partial nail plate avulsion is preferable compared with traditional total distal and proximal plate avulsions. The techniques described herein include partial distal, lateral, proximal, and window techniques, and two variation of the total plate avulsion termed the trap door and lateral nail plate curl avulsion. By using these methods, the surgeon is able to access the targeted nail unit while minimizing trauma to adjacent, uninvolved tissue.
When it is important to visualize the distal matrix, nail bed, and hyponychium, a trap door nail plate avulsion is ideal, exposing the entire nail unit except the proximal-most matrix, cul-de-sac, and eponychium.7, 8 The avulsion starts by undermining the free edge of the nail plate with a Freer elevator or hemostat and applying firm pressure dorsally to the ventral nail plate to avoid trauma to the hyponychium or nail bed epithelium. The instrument is advanced proximally with a firm, pushing
These procedures are performed with oblique incisions in the proximal nailfold, blunt undermining in the plane just above the nail plate, and reflection of one or both sides of the proximal nailfold skin using either skin hooks or suture. Appropriately performed, the ventral surface of the proximal nailfold is exposed and the nail plate can be examined from its inception at the cul-de-sac. Once the plate is
Partial Nail Avulsion For Ingrown Nail
In some instances, the nail plate contains valuable microscopic and/or microbiologic information. This is often the case when evaluating subungual hemorrhage or in any case of suspected onychomycosis. In such instances, the nail plate specimens are labeled and submitted for examination (histology, microbiology, or both) rather than returned to the nail unit. However, in many cases, the avulsed nail plate can remain partially attached and later secured back in anatomic position. If the plate is
One important decision during nail surgery involves choosing the best or most appropriate type of avulsion for each patient's clinical presentation. This requires forethought and an understanding of nail anatomy, histology, and the potential disease processes and neoplasms of the nail unit (Table I).
When assessing a patient's nail, answering several questions may help the surgeon choose the particular type of avulsion that will facilitate a successful surgery while minimizing artifact,
Nail Bed Injury
In some instances, the nail plate contains valuable microscopic and/or microbiologic information. This is often the case when evaluating subungual hemorrhage or in any case of suspected onychomycosis. In such instances, the nail plate specimens are labeled and submitted for examination (histology, microbiology, or both) rather than returned to the nail unit. However, in many cases, the avulsed nail plate can remain partially attached and later secured back in anatomic position. If the plate is
One important decision during nail surgery involves choosing the best or most appropriate type of avulsion for each patient's clinical presentation. This requires forethought and an understanding of nail anatomy, histology, and the potential disease processes and neoplasms of the nail unit (Table I).
When assessing a patient's nail, answering several questions may help the surgeon choose the particular type of avulsion that will facilitate a successful surgery while minimizing artifact,
Nail Bed Injury
In some instances, the nail plate contains valuable microscopic and/or microbiologic information. This is often the case when evaluating subungual hemorrhage or in any case of suspected onychomycosis. In such instances, the nail plate specimens are labeled and submitted for examination (histology, microbiology, or both) rather than returned to the nail unit. However, in many cases, the avulsed nail plate can remain partially attached and later secured back in anatomic position. If the plate is
One important decision during nail surgery involves choosing the best or most appropriate type of avulsion for each patient's clinical presentation. This requires forethought and an understanding of nail anatomy, histology, and the potential disease processes and neoplasms of the nail unit (Table I).
When assessing a patient's nail, answering several questions may help the surgeon choose the particular type of avulsion that will facilitate a successful surgery while minimizing artifact,
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