Nail surgery

Why am I having surgery?

You are either having removal of the nail for a detailed and deeper inspection, a biopsy (sample taken for testing) from part of your nail unit or surgery to remove a lump from around the nail.

What will happen during surgery?

The process will be discussed with you and you will be asked to sign a consent form.

Your finger or toe will be cleaned with antiseptic, to help prevent infection. The surgery is done under a local anaesthetic (while you are awake). The anaesthetic will be injected around the tip of the finger or toe to numb the affected nail. This is known as a digital wing block.

Once the area is numb, the nail will be removed partially or completely and a sample of tissue from a part of the nail unit will be taken for biopsy or the lump will be removed and sent for analysis.

The wound will be closed by bringing the sides together or using nearby skin to cover the area (skin flap). A bulky dressing will be applied to the wound.

If the procedure involves the finger nail, you will be given an arm sling. Keeping your arm in the sling will help to reduce the swelling and the pain after the procedure.

If the procedure involves the toe nail, the bulky dressing on the toe may prevent you from wearing your normal footwear for at least 48 hours. We will provide a suitable item of footwear for this time.

Arriving for surgery

If someone is driving you to The Aspen Centre, Horton Road, Gloucester we suggest that you allow enough time for parking. You should arrive at least 15 minutes before your appointment time. If you are having surgery on your feet, please consider wearing open toed footwear.

Please go to the Dermatology Department reception on the second floor where your details will be checked and you will be shown to the waiting area.

Are there any risks?

• Bruising and/or swelling.
• Infection if the wound fails to heal.
• The lump may not be completely removed.
• The healing process can take longer if you smoke, as this lowers the oxygen levels in your blood.
• Permeant change in appearance to the nail.

Do I need to stop taking blood thinning medication before surgery?

Aspirin

If you are prescribed aspirin, please carry on taking this unless you are told otherwise.

Clopidogrel

If you are prescribed clopidogrel, please check with your GP if it safe for you to stop taking this medication 7 days prior to your surgery. If your GP advises you to continue taking the clopidogrel, please make the clinical team aware.

Warfarin

If you are prescribed warfarin, please make sure that you have your INR (International Normalised Ratio) checked 3 days before your surgery. If your INR is below 3.0, then it is safe to continue warfarin for the surgery. If your INR is above 3.0 discuss with a clinical team member to check if it is safe to proceed. Please contact the Dermatology Department with the result of your INR.

Novel oral anticoagulants such as:

Rivaroxaban/Apixaban/Edoxaban

If you are prescribed any of the above medications, please check with your GP if it safe for you to stop taking this medication the day before your surgery. If your GP advises you to continue taking the medication, please make the clinical team aware.

Low molecular weight heparin

If you are using low molecular weight heparin, please discuss with your GP.

How long will the procedure take?

Surgery may take up to an hour but you will be able to go home soon afterwards. It is important that you keep the next 2 days free as you may need to return for the dressing to be removed.

Can I eat or drink before surgery?

You can eat and drink as normal before the surgery.

Will I be given anaesthetic?

Yes, but you will stay awake as it is local not general anaesthetic. The local anaesthetic will be injected into the base of your finger/toe. You will feel a stinging sensation and the anaesthetic will quickly take effect.

How long will it take for the anaesthetic to wear off?

The anaesthetic will take about 6 hours to wear off.

Wound care

You will have a dressing covering your wound after surgery. You may also have an additional bulky dressing on for 1 to 2 days. It is important to keep the wound and dressing dry until the stitches have been taken out. Keep your hand in a sling if advised to do so.

If the wound bleeds, press firmly on it with a pad of clean tissue for 5 to 10 minutes and keep your hand/foot elevated (raised).

Try to avoid bending, lifting or carrying heavy objects until a few days after the stitches have been removed.

Can I eat and drink after surgery?

Yes, you can eat and drink as normal after your surgery.

When will I have my post-op appointment?

An appointment will be made for you to return to the Dermatology Nurse Treatment Clinic at the Aspen Centre for removal of the bulky dressing and assessment of the wound generally after 48 hours.

Can I drive after the surgery and return to daily activities?

Following your surgery, you will not be able to drive until the dressing has been changed. This is usually 2 days, but may be longer.

Further activities will need to be tailored based on your life style. This should be discussed with your clinician on the day of the surgery.

Please arrange your own transport to and from the appointment.

When will the stitches be taken out?

If you need any stitches to be removed, an appointment will be made for you to attend the Dermatology Outpatients about 1 week after the surgery.

Will I be prescribed any medication?

After the surgery and depending on the procedure, you may be prescribed antibiotics and a short course (usually for 3 days) of pain relief. If you are worried, please contact Dermatology Outpatients for advice (the number is at the end of this page). Outside of normal working hours, please contact NHS 111 for advice.

Can I travel after my surgery?

You are advised not to travel abroad or for long distances after your surgery. This is to allow for any infection or bleeding you may have to be dealt with quickly and for your wound to be checked. Please discuss with your clinician if you plan on traveling.

When can I return to work?

Returning to work after surgery depends on the type of treatment you have had and what your work involves. We suggest that you restrict activities for 4 weeks while mobilising fingers/toes and exercising regularly. This can be discussed at the time of your surgery.

Will I need to let you know I can attend the appointment?

Yes, it is important that you let us know as soon as possible that you are able to attend the appointment. You can contact the Dermatology Outpatient Department on the telephone number at the end of this page.

Keeping our records up to date

If you change your address, telephone number or GP, please contact the Dermatology Department to update your record.

Contact information

If you have any questions or concerns, please contact the Dermatology Department during office hours. If you are concerned and the clinic is closed, please contact NHS 111 for advice.

An answer machine is available if we are unable to take your call. Please leave your name and contact number and we will return your call the next working day.

Dermatology Outpatient Department

Aspen Centre

Tel: 0300 422 8454

Monday to Friday, 9:00am to 5:00pm

NHS 111

Tel: 111