Ingrown toenail removal: Difference between revisions

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*Perform [[Digital block]] using lidocaine without epinephrine or bupivacaine
*Perform [[Digital block]] using lidocaine without epinephrine or bupivacaine
*Clean area thoroughly
*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===
===Complete (lateral) nail removal===

Revision as of 18:24, 21 February 2019

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

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

See Also

References