Background Information:

What are the other Names for the Procedure?

• Onychectomy

What is Nail Removal surgical procedure?

Nail Removal is a procedure that involves removing a part, or all of the toenail or fingernail. It is also known as Onychectomy.

What part of the Body does the Procedure involve?

A Nail Removal procedure involves the toe or finger nail.

Why is the Nail Removal surgical procedure Performed?

Nail Removal procedures may be performed for the following reasons:

• To relieve pain associated with an ingrown toenail or fingernail
• To remove a nail, damaged due to an injury
• Infection within the nail, such as a fungal infection
• Repairing a nail growth abnormality

What are some Alternative Choices for the Procedure?

Your healthcare provider will determine if the nail condition can be treated without removing the same. This is termed as a conservative approach.

What are the Recent Advances in the Procedure?

No recent advances are reported for Nail Removal procedure.

What is the Cost of performing the Nail Removal surgical procedure?

The cost of Nail removal procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Nail Removal surgery on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

Prior to Nail Removal surgical procedure:

How is the Nail Removal surgical procedure Performed?

Nail Removal procedures are performed in the following manner:

• Nail removal is usually done under local anesthesia
• A tourniquet is applied around the finger or toe at its base
• The surgeon then slips a surgical instrument underneath the nail, to separate it from the underlying nail bed
• The nail is then pulled out slowly and gently, and the finger or toe is bandaged

Where is the Procedure Performed?

A Nail Removal procedure is usually performed in an out-patient surgery center facility, or a physician’s clinic/office.

Who Performs the Procedure?

The Nail Removal procedure is performed by any of these medical personnel, with or without assistance from an anesthesiologist:

• General surgeon
• Family doctor
• Dermatologist
• Podiatrist

How long will the Procedure take?

A Nail Removal procedure is usually performed in a few minutes time.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Nail Removal procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Nail Removal procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Nail Removal surgical procedure?

Generally, no diagnostic tests are required, before the Nail Removal procedure.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Nail Removal procedure?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• Can the nail be spared and not removed?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Nail Removal surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia by injection is administered for a Nail Removal procedure.

How much Blood will you lose, during the Procedure?

The blood loss during an uncomplicated Nail Removal procedure is generally minimal.

What are the possible Risks and Complications during the Nail Removal surgical procedure?

The possible risks or complications that may arise during the Nail Removal surgery are:

• Excessive bleeding
• Injury to the surrounding tissues/ structures
• Infection of the surgical wound
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Nail Removal surgical procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise. 

After the Nail Removal surgical procedure:

What are the possible Risks and Complications after the Nail Removal surgical procedure?

The possible risks and complications that may arise after a Nail Removal procedure are:

• Excessive bleeding
• Infection in the surgical wound

What is the Prognosis after the Surgery?

A complete recovery from a Nail Removal procedure is normally achieved. The prognosis is usually excellent, without any serious complications being noted.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain that worsens and swelling of the surgical wound
• Bleeding or fluid drainage from the surgical wound
• Signs of an infection
• Fever, feeling sick
• Dizziness
• Muscle aches, headache
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Nail Removal surgical procedure?

At home, the following post-operative care is recommended, after a Nail Removal procedure:

• Avoid putting any pressure on the affected foot or hand for the next 24 hours, after the procedure. Then, proceed to slowly resume regular/daily activities
• Complete the course of prescribed medication, as advised by your physician
• Take antibiotic medication to help combat or prevent infection, as advised
• Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain (as prescribed)
• Elevate the affected foot while resting for the first 24-48 hours after the procedure; which helps decrease pain
• Wear appropriately fitted footwear, if the procedure was performed on the toenail. In addition to this, wear cotton socks
• Resume showering and keep the wound clean and dry. Gently wash the surgical wound with unscented soap. Apply nonprescription antibiotic ointment to the surgical wound and replace the dressings after showering

How long does it normally take to fully recover, from the Procedure?

Usually, it takes approximately 3 weeks to fully recover from a Nail Removal procedure. The nail will ultimately grow back, after a certain period.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Nail Removal surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility, or a physician’s office/clinic
• An anesthesiologist (if anesthesia was administered)
• A pathologist
• General surgeon, family doctor, dermatologist, or a podiatrist

The patient is advised to inquire and confirm the type of billing, before the Nail Removal procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA