‘ProcNailRemoval

Toenail Avulsion Procedure Note

PRE-OP DIAGNOSIS: Right Ingrown Toe Nail
POST-OP DIAGNOSIS: Same
PROCEDURE: toenail avulsion
Performing Physician: Dr. Klubben

PROCEDURE:
    The area surrounding the skin lesion was prepared and draped in the  usual sterile manner. The patient is placed in the supine position, with  the knees flexed (foot flat on the table) or extended (foot hanging off  the end of the table).
    A standard digital  block was performed, using a 10-mL syringe and a 25-gauge needle, injecting 2.5 mL of 2% lidocaine into the lateral, medial, superior, and inferior aspect of the toe. After waiting approximately 5-10 minutes for the anesthetic to take effect the toe was prepped with povidone-iodine solution.
    A sterile tourniquet was applied for the shortest time possible.
    A single blade of a straight iris was slid under the cuticle to separate the nail plate from the overlying proximal nail fold.
    Using a needle driver the nail was grasped and using gentle traction with slight rocking motion, the nail was released from the matrix and removed.

    Matrictectomy was performed via phenol in place for 1-2 minutes followed by isopropyl alcohol to denature the phenol.

    Vaseline impregnated gauze was applied followed by a bulky gauze pressure dressing.

Followup: The patient tolerated the procedure well without complications.  Standard post-procedure care is explained and return precautions are given.