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Ingrown toenail removal
From WikEM
Contents
Background
- Lateral nail edge grows deep into nail wall → cycle of inflammation and hypertrophic granulation tissue can lead to abscess
- Minor cases can be treated non-surgically
Indications
- Advanced onychocryptosis (heavy granulation tissue, pain with walking)
Contraindications
- Significant granulation tissue precluding partial nail removal
- Multiple comorbidities in a patient not requiring immediate relief
Equipment needed
- Gloves
- Chlorhexidine or betadine
- Syringe with 27-ga needle
- 1% lidocaine without epinephrine or 0.5% bupivacaine
- Gauze
- Thin flat hemostat
- Straight forceps
- Iris scissors
- Aqueous phenol or silver nitrate
Procedure
- Perform Digital block using lidocaine without epinephrine or bupivacaine
- Clean area thoroughly
Partial nail removal
- If only the distal nail wall is inflamed, use iris scissors or an English nail anvil to make an oblique cut through the distal one third of the nail
- Use forceps to help remove the corner
Complete (lateral) nail removal
Removing the entire lateral portion of the nail is the more definitive treatment
- Lift the lateral quarter or third of the nail off of the nail bed with a hemostat
- Cut the nail with scissors or a nail anvil, distal to proximal, parallel to nail wall, with care not to injure the eponychium
- Grasp the nail fragment with the hemostat and pull in a twisting motion distally and toward the remaining nail until removed
- Gently debride the exposed tissue
Matricectomy
Ablating the lateral matrix can decrease recurrence
- Perform complete lateral nail removal as above
- Apply a toe tourniquet for a bloodless field
- Clean and dry base thoroughly
- Ablate nail matrix by applying 1% aqueous phenol solution or silver nitrate
Post-procedure care
- Cover with gauze, instruct to keep clean and dry, wash 2-3 times a day
- No antibiotics unless surrounding cellulitis
Complications
- Recurrence
- Infection
- Bleeding
- Retained nail fragment
