About Your Nail Procedure

This information will help you prepare for your nail procedure in your healthcare provider’s office, such as a nail avulsion or nail biopsy.

A nail avulsion (uh-VUL-shuhn) is a procedure on your finger or toe. It removes some or all of your nail plate (the hard part of your nail). It can also remove the skin below your nail plate.

Your healthcare provider may recommend this procedure if you’re having nail problems that did not get better with other treatments.

A nail avulsion may be done to:

• Treat an infection of your nail.
• Remove a growth from your nail.
• Treat a severe (bad) injury to your nail.
• Treat an ingrown toenail.

A nail avulsion may also be done to treat nail problems caused by your cancer treatment. This can include redness, swelling, oozing, pain, infection, or odor.

A nail biopsy is a procedure to take a sample of tissue of the skin under your nail. It may be done to check for abnormal (not normal) cells.

Before your procedure

• Buy bandages or finger condoms that are made just for fingers or toes. You will need to use these after your procedure. You can buy them at your local drug store.
• Have Acetaminophen (Tylenol®) or ice packs at home to relieve any pain you may feel after your procedure.
• If your procedure will be done on your toe, you may want to bring open-toed shoes to wear after your procedure.
• If you’re driving to your appointment, bring someone who can drive you home after your appointment.
• Wear loose fitting clothing to your appointment.

Shower the night before or the morning of your procedure. You can eat and take all of your medicines as usual.

What to expect during your procedure

About 5 to 10 minutes before your procedure, your healthcare provider will give you an injection (shot). It is local anesthesia (medicine to make an area numb) given close to the affected nail. They may also place a nerve block in your finger or toe. A nerve block is a shot of medicine close to a nerve or group of nerves. It gives pain relief that lasts for a while.

They will wash the affected area with a surgical soap or alcohol. Once the area is numb, your healthcare provider will remove some or all of your nail plate.

After the nail is removed, your healthcare provider will put an antibiotic ointment and dressing (bandage) on your wound. Your healthcare provider may also give you a prescription for an antibiotic to take at home.

Caring for your wound

• Keep your bandage on for _____ hours after your procedure. Keep it dry.
• After _____ hours, change your bandage. Follow the instructions in the “Changing your bandage” section.
• It’s normal for the affected area to feel numb for 1 to 2 hours after your procedure. This is from the local anesthesia.
• If your procedure was done on your toe, avoid wearing tight clothing for about 1 to 2 weeks after your procedure. If your clothing is too tight, you might pull the bandage off when you take your clothes off.
• For _____ weeks after your procedure, do not swim. Do not do any strenuous exercise (such as jogging and tennis). Do not lift more than 5 to 10 pounds (2.3 to 4.5 kilograms).

It takes about 6 months for a fingernail to regrow and about 1 year for a toenail to regrow. The new nail often looks normal.

Changing your bandage

Change your bandage _____ hours after your procedure. Follow these steps:

Change your bandage once or twice a day until your wound is healed. This usually takes 5 to 7 days..

Managing side effects

You may have throbbing, pain, swelling, bleeding, discharge, or sensitivity in your affected finger or toe after your procedure. Follow the guidelines below to help with these side effects.

• For the first 48 hours after your procedure, raise your affected arm or leg as high as possible above heart level. This will help with pain and swelling. Try to keep your affected arm or leg raised as often as you can for 1 week.
• If you have any bleeding, press firmly on your wound with a clean gauze pad for 15 minutes. If the bleeding does not stop after 15 minutes, press firmly for 15 more minutes. If the bleeding still does not stop, call your healthcare provider’s office.
• You can take acetaminophen (Tylenol®) or extra strength acetaminophen (Extra Strength Tylenol®) to help with pain or discomfort, if you choose. Do not take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil®) or naproxen (Aleve®), unless your healthcare provider says it’s OK. These medicines also can increase bleeding.
  • Follow the dose directions on the package. If this dose does not relieve your pain, call your healthcare provider’s office.
  • You may be allergic to acetaminophen or you cannot take it because of a health condition. If so, ask your healthcare provider what you can take instead.
  • If you’re in a cancer treatment clinical trial, ask your oncologist (cancer doctor) what pain medicine you can take.
• You can also hold an ice pack over your wound to reduce pain, swelling, and bruising. Place an ice pack on your wound for 15 to 20 minutes every hour, or follow your healthcare provider’s instructions.

Call your healthcare provider if you have:

• A fever of 100.4° F (38° C) or higher
• Chills
• Any of the following symptoms at your wound or the area around it:
  • More redness or swelling at the tip of your finger or toe
  • More pain or discomfort
  • Skin that’s hard, warm, or hot to the touch
  • Bright yellow or green drainage
  • Bad odor (smell) from your skin or nails
  • Bleeding that does not stop after applying pressure
  • Blue or purple discoloration of the tip of your finger or toe
• Skin symptoms that do not get better or worse
• New or worsening symptoms after starting therapy to treat your skin