From the Guidelines
To resect an ingrown toenail, I strongly recommend a partial nail avulsion under local anesthesia, as this approach has been shown to be effective in managing severe paronychia, which can be associated with ingrown toenails 1. When performing the procedure, it is essential to follow proper techniques to minimize complications and promote healing. The procedure typically involves cleaning the area, injecting a local anesthetic such as lidocaine (1-2%) at the base of the toe for pain control, and then using specialized nail splitters to cut the ingrown portion of the nail vertically from the tip to the base. Some key points to consider when resecting an ingrown toenail include:
- Using proper sterile technique to minimize the risk of infection
- Applying antibiotic ointment (such as bacitracin or mupirocin) and a sterile dressing after the procedure
- Keeping the area clean and changing dressings daily to promote healing
- Soaking the toe in warm water with Epsom salt for 15 minutes 2-3 times daily for several days to reduce discomfort and promote healing
- Managing discomfort with over-the-counter pain relievers like acetaminophen or ibuprofen It is crucial to seek professional medical care from a podiatrist or physician rather than attempting self-treatment, as they can assess the severity of the condition and provide appropriate guidance and care. In some cases, applying phenol (88%) to the nail matrix may be necessary to prevent regrowth of the problematic portion of the nail, as suggested for the treatment of severe paronychia 1. Overall, a partial nail avulsion under local anesthesia is a effective approach for resecting an ingrown toenail, and proper post-procedure care is essential for promoting healing and preventing complications.
From the Research
Resection of Ingrown Toenail
To resect an ingrown toenail, several surgical approaches can be considered, including:
- Partial avulsion of the lateral edge of the nail plate 2
- Matrixectomy, which can be performed through surgical, chemical, or electrosurgical means 2
- Chemical matrixectomy using phenol 3, 4
- Mechanical resection of the lateral matrix horn 3
- Other surgical techniques such as the Winograd technique, Vandenbos procedure, radiofrequency ablation, bipolar diathermy, carbon dioxide laser ablation, Zadik's procedure, Howard-Dubois procedure, Super U procedure, Noël's procedure, knot technique, and toenail paronychium flap 5
Considerations for Resection
The choice of surgical approach depends on the severity and recurrence of the ingrown toenail 5. It is essential to consider the patient's co-morbidities, severity, and associated symptoms when selecting a treatment option 6. Conservative treatments, such as correcting inappropriate footwear, managing hyperhidrosis and onychomycosis, soaking the affected toe, and applying topical steroids, should be considered before proceeding to surgical options 2, 6.
Surgical Techniques
Surgical techniques aim to remove the interaction between the nail plate and the nail fold to eliminate local trauma and inflammatory reaction 2. The use of traumatic surgical techniques, such as the "Emmert plasty" or wedge excisions, is not recommended 3. Phenol cauterization of the lateral nail matrix has been shown to be an effective, safe, and commonly performed method 4.