Surgical nail procedures.

As the so-called "non-surgical" nail procedures grow more and more aggressive and invasive in nature, the cold steel matrixectomy becomes an increasingly viable alternative. Many chemical and thermal matrixectomies are performed under poor aseptic conditions, increasing the risk of wound infection. With chemical matrixectomy, regulation of the level of tissue destruction is uncontrolled and often results in bone injury. The combination of these two elements can result in delayed diagnosis and recognition of osteomyelitis. When a practitioner is faced with a challenging ingrown, dystrophic, or mycotic nail, surgical nail removal should be considered the preferred technique. Etiologic variants of nail deformity, such as hypertrophied ungual labia, subungual exostosis, traumatized nail, and prominent underlying bony condyles, are well managed by the two procedure modifications presented. Advantages in asepsis, quicker wound healing, low reoccurrence rates, and good postoperative cosmesis make surgical nail removal a good choice. The difficulty of the technique and the danger of bone infection have frightened many practitioners away from the cold steel nail procedure. The preferred phenol technique or "p and a" may be simpler to perform, but it yields an unpredictable result. The constant draining and erythema of a phenolized nail may mask an underlying infection. This is one reason why cold steel nails are the preferred technique for nail removal in a diabetic patient. Complications makes cold steel a necessary addition to the surgeons armamentarium. We have presented a brief clarification and historical overview of the four most important contributors to surgical nail removal. These four techniques (Winograd, Frost, Zadik, and Kaplan) have been interwined into the two modifications commonly used today. By following the step-by-step surgical method presented and adding the reader's own successful techniques, a good surgical result can be easily achieved.