Procedure Note: Bilateral Partial Nail Avulsion, Right Great Toe
PROCEDURE: Bilateral partial nail avulsion (wedge resection) of right great toe ingrown toenail
INDICATION: Ingrown toenail, right great toe, bilateral nail borders
ANESTHESIA: Digital ring block with 1% lidocaine without epinephrine
PROCEDURE DETAILS:
After obtaining informed consent and verifying the correct surgical site, the patient was positioned supine with the right foot exposed and prepped. The right great toe was cleansed with povidone-iodine solution.
Anesthesia: A digital ring block was performed using approximately [X] mL of 1% lidocaine without epinephrine, injected at the base of the right great toe at the 2,4,8, and 10 o'clock positions. Adequate anesthesia was confirmed by loss of sensation to pinprick.
Nail Avulsion: A straight hemostat was carefully inserted beneath the lateral nail borders bilaterally, separating the nail plate from the underlying nail bed. Using iris scissors, vertical incisions were made along both lateral nail margins from the distal edge to the proximal nail fold. The lateral nail wedges (approximately [X] mm width each) were grasped with a hemostat and removed with a smooth rolling motion away from the midline. Care was taken to ensure complete removal of the nail spicules without disrupting the nail matrix.
The nail bed and exposed lateral nail grooves were inspected and debrided of any granulation tissue and debris. Hemostasis was achieved with direct pressure using gauze soaked in normal saline.
Matrix Preservation: The nail matrix was intentionally left intact to allow for nail regrowth. No chemical or surgical matricectomy was performed.
ESTIMATED BLOOD LOSS: Minimal (less than 5 mL)
COMPLICATIONS: None
SPECIMEN: Bilateral lateral nail wedges (not sent to pathology)
DRESSING: The toe was dressed with antibiotic ointment and non-adherent gauze, followed by standard gauze wrap.
PATIENT TOLERANCE: The patient tolerated the procedure well without complications.
POST-PROCEDURE INSTRUCTIONS:
- Keep dressing clean and dry for 24 hours
- Begin warm water soaks with Epsom salt twice daily starting tomorrow for 10-15 minutes
- Apply antibiotic ointment and clean dressing after each soak
- Elevate foot when possible for first 48 hours to minimize swelling
- May take over-the-counter analgesics as needed for pain
- Wear open-toed or loose-fitting shoes until healed
- Return to clinic in 2 weeks for wound check or sooner if signs of infection develop (increased pain, purulent drainage, fever, spreading erythema)
- Expected healing time: 2-3 weeks
- Nail regrowth expected over 3-6 months
FOLLOW-UP: 2 weeks or as needed
Clinical Note: This procedure preserves the nail matrix to allow complete nail regrowth. Without matricectomy, recurrence rates may be higher (approximately 40-70% based on general literature), but the cosmetic outcome is superior with full nail restoration. Patient was counseled on proper nail trimming technique (straight across, not too short) and appropriate footwear to prevent recurrence.