Commentary on “Nail surgery: General principles, fundamental techniques, and practical applications”

We congratulate the authors and the journal for covering various aspects of nail surgery in an astute and informative manner.However, we wish to comment on the specific aspect of nail plate avulsion, for the benefit of readers.1.The authors' statement "Nail plate avulsion may be used as a therapeutic procedure in cases with ingrown nails, onychogryphosis, chronic onychomycosis, traumatic nail injuries, chronic paronychia, retronychia, pincer nail, or tumors of the nail apparatus, " in our opinion, needs more discussion for the benefit of practicing readers.Nail avulsion is not "therapeutic" in any of the above conditions, except for possibly retronychia.Herein also, there is a strong case being made to avoid nail avulsion and treat with topical or intramatricial steroids.The need and extent of nail avulsion should be tailored as per the patient's clinical presentation. 2he authors further state that nail avulsion is the first approach in cases with onychogryphosis.It appears recommendatory; however, opinions in general may differ.In fact, it should not be encouraged and rather be avoided in this condition which can be conservatively managed with mechanical debridement and limiting pressure on the nail bed. 3 Nail avulsion offers definitive treatment only if combined with permanent matricectomy or surgical resection of the matrix. 3Following nail avulsion alone, the regrowing nail plate is unlikely to attach to the nail bed and cause further complications as detailed below.2. Authors suggest "partial nail plate avulsion before nail bed biopsy for inflammatory, infectious, or neoplastic disorders." While this may work for the third category (neoplasia), it should be avoided for the first two categories stated, as the majority of the pathological information sought lies at the nail plate-nail bed junction, and is lost if the nail plate is avulsed before biopsy.3. The authors mention the use of "nail-extraction forceps" for the removal of nail plates.This is generally neither required nor encouraged while removing the nail plate, to avoid any damage to the underlying fragile longitudinal ridges of the nail bed, with subsequent possibility of permanent onycholysis.The nail plate is easy to remove, provided that it has been freed from its attachments.The nail plate is an important structure that provides a protective layer over the matrix, and if damaged, can lead to irreversible scarring.The process of nail avulsion is not a benign one, https://jcasonline.com/