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

BACKGROUND

Non-incisional nail surgery is a common surgical procedure performed by clinicians, however, there is considerable variation relating to decision-making for procedure choice, surgical technique, and clinical rationale to inform practice. The aim of this scoping review is to map the extent and type of evidence relevant to surgical approach, decision-making, and clinical rationale informing non-incisional nail surgery in clinical practice.

METHODS

The inclusion criteria were full text papers, available in English that discussed non-incisional nail surgery with or without matrixectomy and included procedural steps and evidence of a clinical rationale to inform practice. A systematic search was conducted of the following databases: Medline, Web of Science, Emcare, CINAHL, ProQuest (Health and Medical), ProQuest (Nursing and Allied Health) and Health Collection. The reference lists of review articles were screened for additional studies. Relevant data were extracted, charted, and grouped into categories. Compiled data were then transferred into summary tables as frequencies and percentages.

RESULTS

A total of 110 articles were included in this review. The articles were published between 1965 - 2025. The procedural steps and clinical rationale were grouped into themes, highlighting a considerable variation in practice relating to tourniquet use, matrixectomy method, concentration of caustic agent, application time and irrigation practices following cauterisation.

CONCLUSIONS

This review has identified inconsistency in the documented practice of non-incisional nail surgery based on published literature spanning a period of 37 years. Specifically, this surgical intervention appears to be informed by historical practice and there is little evidence of a common approach. The authors propose that clinical practice guidelines are needed to provide an evidence-based approach to decision-making in non-incisional nail surgery. The development of clinical guidelines including a structured decision-making framework, would support consistency in practice and facilitate evidence-based decision-making.