Consider anxiolysis with midazolam in anxious children Procedural sedation may be necessary A digital block with 1% lidocaine is always recommended as described in Procedure Digital and Metacarpal Nerve Block Cleanse the site with antiseptic solution A digital tourniquet can be applied once the digit has been anesthetized to minimize bleeding Depending on the extent of the lesion, an angular (or wedge), partial, or complete nail resection may be required An Angular (or Wedge ) nail resection involves removing the distal portion of the nail including the nail spicule Elevate the nail by inserting the tip of a hemostat or scissors under the nail parallel to the nail bed Advance it slowly with a side-to-side or open and close motion and without damaging the nail matrix Use a nail cutter or pointed scissors to cut to approximately one-third to one-half the way to the proximal nail fold and remove a triangular wedge of nail containing the spicule ( Fig 130.39A ) File down the cut edge of the nail, and debride and cleanse the exposed nail bed without damaging the nail groove Apply antibiotic ointment and a nonadherent dressing A Partial nail resection involves removal of the lateral one-fourth to one-third of the nail edge Insert the tip of a hemostat or scissors under the distal edge of the nail plate and parallel to the nail bed Slowly advance it to the level of the eponychium with a side-to-side or open and close motion and without damaging the underlying nail matrix Use a nail cutter or sharp pointed scissors to cut the nail one-fourth to one-third the distance from the lateral edge of the nail and proximally through the eponychium to ensure the nail root is excised ( Fig 130.39B , part A) A hemostat should be used to grab the lateral nail segment and remove it using a gradual steady rotating motion toward the remaining nail edge to minimize damage and resect the segment in one piece ( Fig 130.39B , part B) Examine the resected portion to ensure it contains the nail root as desired Debride and clean the now exposed nail bed ( Fig 130.39B , part C) A strip of gauze or cotton can be placed beneath the cut intact nail edge to elevate it slightly and avoid recurrence Apply antibiotic ointment and a nonadherent dressing