Antibacterial or antibiotic ointment (for example, BetadineR, BacitracinR).
(10) Sterile gauze pads (4 x 4 inch).
f. Procedure. Follow this procedure for removal of the toenail:
With the patient supine, scrub and drape the toe in a sterile fashion.
Administer local anesthetic in ring-block fashion like this:
(a) The total solution should be 5 ml.
(b) Raise a wheal at the base of the toe on the extensor surface on the
(c) Direct the injection toward the plantar surface to envelop both the
extension and plantar branches of true digital nerve on that side.
(d) Deposit 1 ml at each site.
(e) Retract the needle slightly.
Redirect the needle horizontally across the dorsal surface of the
(g) Inject 0.5 ml under the skin at the base of the toe on the opposite
Perform a second puncture at that site.
Advance the needle in the plantar direction.
Deliver 1 ml of anesthetic to each branch of the digital nerve.
(3) When the anesthesia is achieved, secure a sterile rubber band with a
straight hemostat to serve as a tourniquet.
Remove the nail from the nail bed following this procedure:
(a) Using a flat pointed blade of scissor, straight hemostat, or narrow
periosteal elevator, introduce and advance the instrument upward and against the nail
and away from the nail bed. This minimizes injury and bleeding.
(b) Completely free the nail at its base under the edge of the cuticle.
This allows the nail to be completely removed and provides exposure to the germinal
tissue of the nail bed.