Aseptic techniques should be used and universal precautions should be adhered to. (Figure 1)
Local anaesthetic should be infiltrated on both sides of the toe. 2 to 3mls of a 1% Lignocaine solution on either side should be sufficient to provide adequate anaesthesia. (Figure 2)
After testing to ensure that the anaesthetic has taken effect, a tourniquet is applied to secure a bloodless operating field. A sterile rubber band can be used, alternatively, the cut-off fingertip of a sterile glove as in this picture. (Figure 3)
By using a pair of scissors or a scalpel, a wedge excision of the outer one-fourth of the nail plate can be done. This excision should be continued from the tip of the nail down to the nail fold. (Figure 4)
The nail plate is then securely gripped and avulsed with a simple twisting motion. If avulsion is incomplete, care must be taken to re grasp and completely remove the remaining nail plate under the nail fold. (Figure 5)
Care should be taken to excise the nail bed and ablate the nail matrix by using a small curette. Adequate analgesia is important to ensure patient comfort at this stage. (Figure 6)
Be sure to remove the tourniquet!! (Figure 7)
A nice firm bandage is applied taking care not to compromise the circulation.(Figure 8)