Toenail Removal Facts

Are you thinking about toenail removal to eliminate your toenail fungal? Yes? Then, you're not alone. Sometimes, no matter what you do nail fungal infections just will not go away. Nail fungal infections also known as onychomycosis are known for being persistent and difficult to treat.

Oral antifungal medications work wonders for getting rid of most bouts of onychomycosis. But, they don't always do the trick. For some people, toenail fungal infections keep returning over and over again.

Toenail removal is often the last resort for those dealing with nail fungus. Of course, nails do grow back. But, they can regrow ingrown or thickened.

What to Expect

If you've never seen toenail removal surgery, let me warn you. It can be pretty graphic. Thankfully you don't have to look at your own foot while the procedure is being performed. Here's a primer on what to expect before, during, and after the surgery.

Prior to removal, some doctors give their patients an oral antibiotic before the toenail is removed to prevent bacterial infections. Most doctors can perform removal in their office or at an outpatient surgical center. As this is an outpatient procedure, you can expect to go home the same day as the surgery.

Before the removal begins, the doctor will use an injection of medication to numb the surgical site. Usually, xylocaine or a similar medication will be used. While you may not feel pain, tugging and pulling sensations due to surgical instruments is typical.

A tourniquet is wrapped around the affected toe to control bleeding. The surgical area is cleansed with Betadine or another antimicrobial solution.

When it comes to nail removal, your physician may remove part of your nail (debridement) or all of the nail (avulsion). The amount of nail removed will depend upon how badly the nail is damaged.

Mulling the Matricectomy...

As a patient, you can choose to have the nail matrix removed. This option also called a matricectomy is good if you simply want to remove all of the nail and don't want to regrow your toenail.

The matrix is an area at the base of the nail where nails are formed. If the matrix is destroyed, the nail will not grow back and nail fungal problems will be totally eliminated.

To visualize the matrix, your doctor will place a blue dye on it prior to removal. To destroy the nail matrix, phenol, sodium hydroxide, or another caustic chemical is applied to the area. The matrix can also be removed by surgical means, laser, and electrical currents.

Removing the Nail Plate

The nail plate is what we call the toenail. Chemical, manual, and laser removal of the plate are all viable options. Chemical removal is an option for those with thick nails and those who can't do surgical removal. A compound containing 40% urea can be applied to the nail plate to help dissolve the nail.

The skin around the nail is protected with tape. Urea is placed on the diseased nail and is then covered. It takes a few days for the nail to soften. One can return to the doctor 's office to remove rest of nail.

With manual removal of the nail plate, the skin around the nail is loosened. Then, a tool is used to fully remove the plate.

Risks of Nail Removal Surgery

Like all surgeries, toenail removal comes with risks. Infections are the most common risk of any surgery. Proper post-surgical care is required when handling an affected toe. Watch for signs and symptoms of bacterial infections including redness, swelling, and oozing pus.

Allergies to pre-op and post-operative medications can also play a factor in how well one fairs with nail surgery.

With chemical, laser, or electrical removals, burns are a potential issue. Although rare, the possibility of mild burns and peeling skin are something you should be aware of.

Nail removal may not be the best option for the elderly or those with many infected toenails. Healing of the surgical site can be compromised in seniors who often have preexisting health problems and poor circulation to extremities.

Post Toenail Removal Care Tips

  1. Elevate your foot after surgery for 1 to 2 days
  2. Take pain relievers as prescribed
  3. Soak affected toes in warm water
  4. Keep hands clean when handling wounds
  5. Cover the surgical site with clean sterile gauze
  6. Apple triple antibiotic ointment to area

Having had patients with toenails removed, I can tell you it takes a few weeks for the operative site to fully heal.

Expect some clear drainage from the site. Obviously, don't run a marathon until the toe fully is healed. Follow up with your doctor as they monitor your progress.

If you're a smoker, be careful. Smokers take longer to recover from surgeries. Those with compromised immune systems also take some time to get better. It may take one to two years for a toenail plate to regrown as long as the matrix is in intact.

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