About Your Nail Avulsion

This information will help you prepare for your nail avulsion procedure.

A nail avulsion is an in-office procedure in which the nail plate (hard part of your nail) is removed from your affected finger or toenail. A nail avulsion can also be done to:

  • Treat infections of the nail.
  • Remove growths from the nail.
  • Treat severe injuries to the nail.
  • Treat ingrown toenails.
  • Biopsy the skin under the nail. This involves taking a sample of your skin.

You may need a nail avulsion if you have problems with your nails, such as redness, swelling, oozing, pain, infection, and odor, after taking anticancer treatments. These treatments include:

  • Taxanes, such as:
    • Docetaxel (Taxotere®)
    • Paclitaxel (Taxol®)
  • Targeted therapies, such as:
    • Cetuximab (Erbitux®)
    • Erlotinib (Tarceva®)
    • Gefitinib (Iressa®)
    • Lapatinib (Tykerb®)
    • Panitumumab (Vectibix®)
    • Trastuzumab (Herceptin®)

Your doctor may recommend a nail avulsion if your nail problems have not gotten better with other treatments, such as topical antibiotics (applied on the skin), oral antibiotics (taken by mouth), or chemical cauterization (destroying the damaged tissue with medical chemicals).

Before Your Procedure

Tell your doctor if:

  • You are taking:
    • Any medication to thin your blood, such as aspirin, aspirin/extended-release dipyridamole (Aggrenox®), clopidogrel (Plavix®), dabigatran (Pradaxa®), enoxaparin (Lovenox®), rivaroxaban (Xarelto®), or warfarin (Coumadin®)
    • Any nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil®) or naproxen (Aleve®)
  • You are allergic to:
    • Anesthesia (medication to numb an area or make you sleep during surgery)
    • Latex
    • Tape adhesive
    • Bacitracin
    • Iodine/chlorhexidine
  • You have:
    • Had a lymph node dissection on your affected arm or leg (the arm or leg having the nail avulsion).
    • Had joint replacement within the past 3 months.
    • A low platelet count or a bleeding disorder.
    • Hepatitis or any other infectious diseases.
    • A pacemaker or an implantable cardioverter defibrillator (ICD).
    • Diabetes.

You should also buy bandages that are made specifically for fingers or toes at a drug store. You will need to use these after your procedure.

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The Day of Your Procedure

Shower the night before or the morning of your procedure. You may also want to bring loose shoes to make your ride home comfortable, if you are having a toenail avulsion.

You can eat and take all your medications as usual.

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During Your Procedure

  • You will receive local anesthesia to the affected nail(s) 5 to 10 minutes before your procedure begins. This will numb the area.
  • Your doctor will remove a piece of the nail or the whole nail.
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After Your Procedure

  • You will have a topical antibiotic ointment and dressing on your wound. Keep the dressing on and dry for 24 hours after your procedure. After 24 hours, change the dressing. See the section “Changing your dressing” for more information.  
  • It is normal to feel numbness in the affected area for 1 to 2 hours after your procedure.
  • You may experience throbbing, pain, swelling, bleeding, discharge, or sensitivity at the affected area after your procedure. If your doctor approves, you can take regular or extra-strength acetaminophen (Tylenol®) for any discomfort.
  • For the first 48 hours after your procedure, raise your arm or leg that had the avulsion as high as possible to decrease swelling and pain.
  • If you have any bleeding, press firmly on your wound with a clean gauze pad for 15 minutes. If the bleeding does not stop, repeat this step. If the bleeding still hasn’t stopped after repeating this step, call your nurse.
  • Do not swim or do any strenuous exercise or heavy lifting for _____ weeks after your procedure.
  • It takes about 6 months to regrow a fingernail and about 1 year to regrow a toenail. The new nails usually look normal.

Changing your dressing

You will need to change your dressing 24 hours after your procedure. Follow the steps below.

  • First, soak your finger or toe in lukewarm water for 15 minutes. This will prevent any discomfort from your dressing sticking to your wound. Then, remove the dressing.
  • Wash your wound with soap and water and pat it dry with clean gauze.
  • Apply ___________ ointment to the wound and cover it with a new dressing. Keep the tip of your finger or toe open to the air so that you can check for any blue or purple discoloration or redness.
  • Change your dressing once or twice a day until your nail plate is healed. This usually takes 5 to 7 days.
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Call Your Doctor if You Have:

  • A temperature of 100.4º F (38º C) or higher
  • Increased redness and swelling or warmth at the tip of your finger or toe
  • Blue or purple discoloration of the tip of your finger or toe
  • Any of the following symptoms at your wound or the area around it:
    • Increased pain or discomfort
    • Bright yellow or green drainage
    • Persisting or worsening odor
    • Bleeding that does not stop after applying pressure
  • Any questions or unexpected problems
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