Ingrown toenail removal

Background/Indications

• Lateral nail edge grows deep into nail wall
• Cycle of inflammation, hypertrophic granulation tissue, can lead to abscess
• Minor cases can be treated nonsurgically
• Removal indicated for advanced disease – 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
• Alcohol swab
• 27-ga needle, syringe
• 1% lidocaine without epinephrine
• 0.5% bupivacaine
• Aqueous phenol or silver nitrate
• Gauze
• Thin flat hemostat
• Straight forceps
• Iris scissors

Procedure

• Digital block using 1% lido without epi, consider adding bupivacaine
• Clean area thoroughly

Partial nail removal

1. 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
2. Use forceps to help remove the corner

Complete (lateral) nail removal

Removing the entire lateral portion of the nail is the more definitive treatment

1. Lift the lateral quarter or third of the nail off of the nail bed with a hemostat
2. Cut the nail with scissors or a nail anvil, distal to proximal, parallel to nail wall, with care not to injure the eponychium
3. Grasp the nail fragment with the hemostat and pull in a twisting motion distally and toward the remaining nail until removed
4. Gently debride the exposed tissue

Matricectomy

Ablating the lateral matrix can decrease recurrence

1. Clean and dry thoroughly
2. Apply a toe tourniquet for a bloodless field
3. Ablation of matrix can be done using 1% aqueous phenol solution or silver nitrate, among other techniques

Post-procedure care

• Cover with gauze, instruct to keep clean and dry, wash 2-3 times a day
• No antibiotics unless cellulitis

Complications

• Recurrence
• Infection
• Bleeding
• Retained nail fragment

Source

emedicine

See Also

• Paronychia