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Nail avulsion is the most common surgical procedure performed on the nail unit. It is the excision of the body of the nail plate from its primary attachments, the nail bed ventrally and the PNF dorsally. Avulsion of the nail plate may be initially performed to allow full exposure of the nail matrix before chemical or surgical matricectomy. Other indications for performing nail avulsion are to treat recalcitrant onychocryptosis; to excise tumors of the nail unit; to allow full examination and exploration of the nail bed, the nail matrix, the PNF and the LNF, and the nail grooves for the presence of pathology; or to use as a preliminary step before performing biopsy on the nail bed and the nail matrix. Avulsion of the nail plate is frequently used as a therapeutic adjunct in long-standing fungal infections of the nail, such as chronic onychomycosis, and in acute bacterial infections. In traumatic nail injuries, avulsion may be used to evaluate the stability of the nail bed or to release a subungual hematoma after failed puncture aspiration.
Paring the nail plate is the process of taking off pieces of the nail in a transverse or longitudinal fashion to fully observe an involved area on the nail bed. In the case of verrucae, nail paring may be performed to determine the extent of disease involvement of the nail plate and the underlying nail bed. The 2 primary methods for performing nail avulsion are distal avulsion and proximal avulsion. A third method, chemical avulsion with urea paste, is a nonsurgical avulsion technique that may be performed. A partial or complete nail avulsion can be performed, depending on location and extent of disease. Surgical nail avulsion is not a definitive cure in cases of nail dystrophy caused by onychocryptosis, nail matrix disease, or extensive nail bed pathology (eg, SCC). Depending on the indication, the nail surgeon must exercise restraint in the decision to perform nail avulsion because cosmetic and functional outcomes should be considered. A distorted curvature of the newly formed nail plate and an elongated, thickened nail due to hypertrophy of the nail plate and the nail matrix are complications associated with multiple or repeated avulsion procedures.
Before avulsion, anesthesia of the digit is achieved through a digital block performed with 1% lidocaine. A Penrose drain secured with a hemostat clamp is used for hemostasis. Any of the following 3 blunted instruments may be used to separate the nail plate from its attachments: the mosquito hemostat, the Freer septum elevator, or the dental spatula. In distal nail avulsion, the instrument is introduced under the distal free edge of the nail plate to separate the nail plate from the underlying nail bed hyponychium on its ventral surface. All attempts at separation are directed proximally toward the matrix, with significant resistance occurring until the matrix is reached. When the matrix is contacted, the surgeon usually experiences less resistance and might feel a laxity because of a weaker attachment. After reaching the matrix, the elevator is reinserted with several longitudinal forward and backward strokes performed side by side until the nail bed is completely freed from the overlying nail plate. To free the nail plate from its association with the PNF and the cuticle, the Freer elevator is inserted under the PNF in the proximal nail groove between the eponychium and the nail plate. Aggressively inserting the instrument into the proximal nail groove causes unnecessary injury and postoperative morbidity, and it should be avoided. Next, the hemostat clamp is used to gently secure and remove the nail plate. If the hemostat blade is used, the serrated, toothed portion of the blade must be oriented to lie directly against the undersurface of the plate and the PNF.
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Fantasy has entered nail fashions in recent years. Both women and men can be disturbed by nails that split, chip, and break which may affect employability, self-esteem, and interaction with other people. Moreover, any abnormality of the nail can cause impaired function of the hand or foot. Nail cosmetics is gaining popularity among dermatologists as they can improve the condition and appearance of the nails if used wisely. Since the nails are often difficult to treatand takes longer time to respond, nail cosmetics may be an effective support to medical treatment. They may help the patients to cope with their nail dystrophies while waiting for treatment to show its efficacy. It may also be the only choice to hide irreversibly damaged nail. Although, theirpopularity is greatest among women, the market for male manicures is also growing rapidly. The adornment and grooming of nail is an enormous industry, with over US $ 6 billion spent annually at nail salons in the US alone. Although, we do not have this data in India, it is well known that the nailsalons ismushrooming rapidly in Indian metro cities.Nails are painted with exotic colors and designs. Ornaments and even expensive jewels are used to decorate the nails. Nails have thus created a great deal of interest among people as well as among cosmetic industries.However, injudicious use of nail cosmetics and nail grooming tools itself may result in adverse reactions promoting nail disorders and sometimes even deformities.
HISTORY OF NAIL ART
Ancient women used to strive for beauty and were eager to discover various means to capture the imagination of men. It is due to this factor that nail art origins were concentrated mainly in the sphere of men-women relations. History dates back to 5000 years ago when henna was used for the first time for manicure in India.Nail art origins are traced from the term mehendi, used synonymously for henna, derives its name from the Sanskrit word mehandika. In ancient India when a young girl has had her first menstrual cycle, she was considered ready to enter into a marriage and this was when her lips and fingernailswere painted bright redhenna.
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Abdul | Payyannur, Kerala