From the Guidelines
A partial nail avulsion is recommended for this 28-year-old patient with an ingrown toenail, involving removal of the affected portion of the nail under local anesthesia, followed by phenolization to prevent regrowth. The procedure should start with administering 1-2 mL of 1% lidocaine without epinephrine as a digital block at the base of the toe 1. After achieving anesthesia, use a nail splitter to cut the nail vertically from the distal edge to the proximal nail fold, then use hemostats to remove the affected nail portion. Apply phenol (88%) to the exposed nail matrix for 1-3 minutes to prevent regrowth, followed by thorough alcohol irrigation.
Post-Procedure Care
- Dress the wound with antibiotic ointment (such as bacitracin or mupirocin) and a non-adherent dressing.
- Instruct the patient to keep the area clean, change dressings daily for 1-2 weeks, elevate the foot when possible, and wear open-toed shoes or sandals initially.
- Prescribe appropriate analgesics like acetaminophen 500-1000 mg every 6 hours or ibuprofen 400-600 mg every 6-8 hours for pain.
- Consider a short course of antibiotics (such as cephalexin 500 mg four times daily for 7 days) if there's significant infection, as suggested by guidelines for managing onychomycosis 1.
Follow-Up
Schedule a follow-up in 1-2 weeks to assess the healing progress and address any potential complications. This procedure is effective because it removes the offending nail edge while phenolization destroys the nail matrix, preventing recurrence which occurs in up to 70% of cases without chemical matricectomy. The provided guidelines, although focused on taxane-induced onycholysis and onychomycosis management, support the importance of proper nail care and intervention in cases of nail disorders, underscoring the rationale for partial nail avulsion in the context of an ingrown toenail 1.