Clinical Rationale for Procedural Steps When Performing Non-Incisional Nail Surgery: A Scoping Review

Area of Science:

• Podiatric surgery
• Dermatologic surgery
• Surgical technique

Background:

• Non-incisional nail surgery is a common procedure with significant variability in decision-making, surgical techniques, and clinical rationale.
• Existing practices lack a standardized approach, impacting procedural consistency.
• This variability necessitates a review of current evidence to inform clinical practice.

Purpose of the Study:

• To map the evidence regarding surgical approach, decision-making, and clinical rationale in non-incisional nail surgery.
• To identify variations in procedural steps and the underlying clinical rationale.
• To provide a foundation for developing evidence-based clinical guidelines.

Main Methods:

• A scoping review of full-text English articles discussing non-incisional nail surgery.
• Systematic database searches (Medline, Web of Science, Emcare, CINAHL, ProQuest, Health Collection) and reference list screening.
• Data extraction, categorization, and summarization into frequency and percentage tables.

Main Results:

• 110 articles published between 1965-2025 were included.
• Significant variations were observed in tourniquet use, matrixectomy methods, caustic agent concentration, application time, and post-cauterization irrigation.
• The findings highlight a lack of a common, evidence-based approach.

Conclusions:

• Inconsistency in documented non-incisional nail surgery practices spans 37 years of literature.
• Current practices appear rooted in historical precedent rather than robust evidence.
• Clinical practice guidelines and a structured decision-making framework are essential to standardize care and promote evidence-based practice.