From the Research
Ingrown toenail avulsion during pregnancy is generally safe when necessary, but certain contraindications should be considered, particularly the use of certain anesthetics and the presence of active infection or underlying health conditions that may increase the risk of complications. The primary contraindication is the use of certain anesthetics, particularly those containing epinephrine, which may reduce placental blood flow, as noted in general medical practice 1, 2. Local anesthetics like lidocaine without epinephrine are preferred when necessary. Oral antibiotics that may be prescribed post-procedure should be pregnancy-safe options such as penicillins or cephalosporins rather than fluoroquinolones or tetracyclines, which are contraindicated in pregnancy.
Key Considerations
- Patients with poorly controlled diabetes, peripheral vascular disease, or immunocompromised status require additional caution due to increased infection risk and delayed healing, as these conditions can significantly impact morbidity and mortality 3, 4.
- The procedure should be postponed in cases of active infection at the surgical site until resolved with appropriate antibiotics, to minimize the risk of complications and promote optimal healing.
- While pregnancy itself is not a contraindication, the procedure is best performed during the second trimester when possible, avoiding the first trimester (period of organogenesis) and third trimester (when positioning for the procedure may be difficult), as suggested by the most recent study on the topic 5.
Surgical Technique
The most recent study on partial nail avulsion suggests a new surgical modification using an 11 no. surgical blade instead of nail clippers, leading to less trauma to the nail bed and finer post-procedure outcomes 5. This technique may be considered for patients undergoing ingrown toenail avulsion during pregnancy, as it may reduce the risk of complications and promote faster recovery.
Quality of Life
The benefits of relieving pain and preventing infection from an ingrown toenail must be weighed against any potential risks, considering the impact on the patient's quality of life and the potential for complications during pregnancy 1, 2, 3, 4, 5.