Lateral Nail Avulsion and Chemical Matrixectomy

Anaesthesia
- Digital nerve block using local anaesthetic without adrenaline
Lateral Nail Avulsion
- Apply tourniquet at base of toe
- Use nail splitter or scissors to cut the lateral 15–25% of the nail longitudinally
- Remove the lateral nail segment completely, down to the matrix
Chemical Matrixectomy
- Dry the nail bed carefully
- Apply 80-90% phenol to matrix to the exposed lateral matrix area using a cotton-tipped applicator
  - Typically applied for 30-40 sec
  - Rotate applicator to ensure full contact with matrix
Post-Procedure Care
- Remove tourniquet
- Dress with non-adherent dressing
- Advise foot elevation and gentle wound care
- Warn about mild drainage for several weeks while healing

Zadek’s Procedure

Anaesthesia
- Digital nerve block with local anaesthetic (usually without adrenaline)
- Apply digital tourniquet at base of toe
Surgical Steps
- Make a small cut at the corner of the nail base (lateral nail fold) to access the germinal matrix
- Removes entire nail plate and germinal matrix, but leaves sterile matrix behind (the “nail bed”)
  - Germinal matrix extends from 1-2mm distal to lunula
  - or 1/3 distance between cuticle to distal nail edge
  - to under eponychium
  - and laterally quite far under the lateral nail folds almost to mid-lateral line
  - All must be removed
Closure
- Suture the incision with absorbable or non-absorbable stitches
Postoperative Care
- Non-adherent dressing
- Elevation of foot
- Antibiotics if signs of infection
- Wound care with regular dressing changes until healed
Advantage is that in about 60% patients sterile matrix will continue to form flaky keratin masses that cosmetically looks like a “nail”
Recurrence as low as 4%