ABSTRACT
Nail avulsion is the most common nail operation. Multiple indications for removal of the nail plate include onychocryptosis, nail deformity, extensive nail infection, trauma, or evaluation of underlying neoplasm. Total nail avulsion refers to the removal of the entire nail plate from its two foci of adherence, the nail bed and the proximal nail fold. A variety of methods for total nail avulsion have been described, including chemical avulsion, distal approach and surgical avulsion, and proximal or anterior approach surgical avulsion. By far the most common technique for nail avulsion is the surgical distal approach. For this technique a blunt surgical instrument is introduced under the distal free edge of the nail plate and pushed proximally to the matrix. The instrument is then withdrawn and reinserted repeatedly in a linear longitudinal fashion over the entire nail bed to separate the nail plate from the underlying nail bed. The proximal nail fold can be loosened in a similar fashion by inserting the blunt instrument back and forth between the horny layer of the proximal nail fold and the nail plate. After
the nail is freed from the bed, the plate is grasped with a clamp and removed with pulling traction and rolling motion.
