Views and Practice Mastering basic nail procedures

Examination and surgical intervention of nail unit lesions are often hindered by its natural hard keratinous nail plate. Knowledge of the basic anatomy of a nail unit and surgical pathology of a condition facilitate the delivery of an appropriate and effective treatment. The mild form of common ingrown toenail can be managed by tube insertion which entails inserting without anaesthesia a small calibre plastic tube along the ingrown part. It often gives immediate symptomatic relief and may obviate the need of later surgical intervention. A nail elevator is a good tool for nail plate avulsion, especially useful in dealing with a thickened nail which often imposes difficulty for clinicians to offer effective medical treatment. Exploration of a nail involves partial or complete removal of a nail plate, and/or reflection of the proximal/lateral nail fold thereby exposing the nail bed and nail matrix. The incision line on the lesion is influenced by the location and spatial orientation in respect of nail bed and nail matrix. Clear visualization of the nail bed or matrix is dependent on a bloodless operating field. A well applied digital tourniquet is indispensable for one to achieve a bloodless field.