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Techique of Total Nail Plate Avulsion

- Technique:
    - preoperative considerations;
    - goal is to separate the nail atraumatically from the bed and the proximal nail fold;
    - insert freer elevator or fine nosed hemostat under the edge of the nail plate and push proximal;
          - a plane of cleavage will form between the nail bed and plate;
          - as the plane of cleavage extends proximally to the matrix, a sudden "give" will be felt;
                - at this point be careful not to push too hard;
                - now move the elevator in a side to side motion to free the the nail from the lateral margins;
          - next, insert the freer under the cuticle (proximal nail fold) and slide the freer from side to side;
          - then, grab the nail with a hemostat and avulse with a rolling-twisting motion