Nail surgery

Why am I having surgery?

You are either having removal of the nail for inspection of the nail bed or a biopsy (sample taken for testing) from part of your nail unit or surgery to remove a lump 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 Chloraprep® and/or Tisept®. The surgery is done under a local anaesthetic (while you are awake). The anaesthetic will be injected at the base of the finger or toe with the affected nail. This is known as a digital wing block.

Once the area is numb, a sample of tissue from a part of the nail unit will be taken for biopsy or the lump will be removed. 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. You will need to keep the sling on for 24 hours; therefore, you will not be able to drive yourself home.

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. Therefore, you will not be able to drive yourself home.

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

Will I be left with a scar?

You may have a groove like scar on your nail following the surgery.

Can I drive after surgery?

You should not drive after the surgery. You will need to arrange for someone else to drive you home or use another form of transport.

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.

Do I 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 take clopidogrel please ask your GP if it is safe to stop this medication for a short time. Ideally, we would need you to stop for 7 days before your surgery. However, your GP may ask you to continue taking the clopidogrel.

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 your surgeon to check if it is safe to proceed. Please contact the Dermatology Department with the result of your INR on

Tel: 0300 422 5396

Rivaroxaban/Apixaban

Please check with your GP if it is safe to stop either of these medicines for a short time.

Ideally, we would need you to stop taking the medicine the day before your surgery. If you are not advised to stop the medication, it is fine to continue if your GP feels it is best.

Low molecular weight heparin

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

Arriving for surgery

If you are travelling by car to The Aspen Centre, Horton Road, Gloucester we suggest that you allow enough time for parking. You should arrive at least 10 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.

Will I be given anaesthetic?

Yes, but you will stay awake as it is local not general anaesthetic. The local anaesthetic is 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.

Can I eat and drink after surgery?

Yes, you can eat and drink after your surgery.

Wound care

You will have a dressing covering your wound after surgery and may 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.

When will I have my post-op appointment?

An arrangement 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 after 48 hours.

When will the stitches be taken out?

An appointment will be given to you to have your stitches taken out in Dermatology Outpatients about 1 week after 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 leaflet). 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 until the stiches are removed. This is to allow for any infection or bleeding you may have to be dealt with quickly.

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 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

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 Department

Aspen Centre

Tel: 0300 422 5396

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