| Summary: | The hard nail plate forms the majority of the nail unit apparatus. There are many disorders of the nail unit that may require a surgical approach, with the ingrowing toenail being the most common. The condition occurs when the nail plate punctures the sulcus, giving rise to pain and inflammation. When the nail does this, attempts at healing lead to the formation of hypergranulation tissue and secondary infection. The condition can be staged as 1, 2 or 3, with nail surgery often required for more advanced and chronic presentations. Nail surgery for permanent removal of part or all of a nail unit can be performed via incisional or physical ablative techniques. Currently, the most regularly performed technique in the UK is chemical ablation, with the phenol-alcohol technique by far the most popular procedure under this heading. The author will discuss partial and total avulsion techniques using phenolic nail matrix ablation, and place these within the overall phases of surgery. Brief mention will be made of incisional techniques, with a case study at the end of this article to prompt further thought and discussion.
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