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Fellows Podiatry Blog

Nail Surgery (PNA and TNA)

By September 20, 2023September 26th, 2023No Comments

Nail surgery

 

Nail surgery is performed by a Podiatrist in a clinical environment under a local anaesthetic in order to remove a full nail or partially remove a section of nail.  This is carried out when the nail is causing pain and irritation to the surrounding tissue, which may be inflamed and infected as a result.  In may be necessary to have a course of antibiotics to get any bacterial infection managed but this will not resolve an in-growing toe nail.

The nail may also have a fungal infection that has not been successfully treated with topical antifungal preparations (treatments applied to the nail) and oral medication is not an option.  A full medical history and lifestyle will be questioned to ensure that the procedure is safe to be carried out and that circulation is sufficient.  Patients’ medication must also be taken into consideration for safe administration of the local anaesthetic and to allow the wound to heel.

Phenol or no phenol?

Prior to toe nail surgery, the best method of procedure and outcome will be discussed with the patient as to whether phenol is used to stop a section of nail or stop the whole nail from regrowing.  Phenol is recommended to prevent the ingrowing nail or a dystrophic/fungal nail from regrowing and causing a potentially causing a reoccurring problem.  If the nail is removed due to it being infected with fungus, antifungal treatments will then be advised post operatively, in order to give the new regrowth of nail its best chance to being healthy.

Treatment

Following a consultation, any risks have been assessed and consent gained, the treatment can commence.

The local anaesthetic is administered with two small injections, either side or the toe towards the base of the toe which numbs the toe, allowing painless removal of the offending nail.   There are no incisions made to the toe as the nail can be separated with a elevating instrument and removed with forceps.  Often there is little to no blood during the procedure, unless there are large areas of hypergranulation tissue which is very vascular and bleeds a lot.  The patient will be informed of this if there is hypergraunlation present.  To stop any bleeding, a torniquot is used around the base of the toe. The procedure itself is very quick and is no longer than 15minutes.

Post Operative advice

There is a superficial wound created and it is important to keep the area clean, dry and covered with a sterile dressing.  The lesion can be cleaned with saline or clinicept every couple of days and a clean sterile dressing reapplied.  If phenol has been used to prevent a nail from regrowing, the wound can take up to 6 weeks to dry up and heal.  If phenol isn’t used, the healing process is often much faster.  A small amount of weeping and exudate is normal in the first few weeks and this should reduce as time goes on.  Infection is a risk but if the dressing is kept clean and dry and post operative advice is followed, usually infection isnt an issue.

The inflammation and weeping should reduce over time and the redness should reduce and therefore the pain will reduce.  Patients often say that the postoperative discomfort is much less pain than an ingrowing toe nail itself.

If you would like an assessment and have a reoccurring ingrowing toe nail and would like to consider your options for nail surgery, please contact me for an appointment in Heswall, Wirral.

Joanna is a BUPA, AVIVA and VITALITY  Health insurance Provider. Please obtain an authorisation number for treatment prior to your appointment.  Call or email for further discussion.  Joanna is fully qualified Podiatrist, registered with the Health Care Professionals Council and the Royal College of Podiatry.

 

painful fungal nail

fungal nail removed, 1 month post. op.

involuted nail

fungal nail removed, 3 months post op.

nail surgery, sterile dressing

lateral/fibula in growing nail

PNA with phenol, torniquot

2 weeks post op PNA