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Ingrown Toenail Surgery Aka Partial Nail Avulsion
By Jahyung Kim 1, † , Sanghyeon Lee 2, † , Jeong Seok Lee 1 , Sung Hun Won 1 , Dong Il Chun 1 , Young Yi 3 and Jaeho Cho 4, *
(1) Background: Ingrown toenail is a common disorder of the toe that induces severe toe pain and limits daily activities. The Winograd method, the most widely used operative modality for ingrown toenails, has been modified over years to include wedge resection of the nail fold and complete ablation of the germinal matrix. We evaluated the outcomes of original Winograd procedure without wedge resection with electrocautery-aided matrixectomy. (2) Methods: We retrospectively analyzed the outcomes of patients who underwent surgery for ingrown toenails at a university hospital for two years from November 2015 to October 2017. Surgery was performed in 76 feet with a mean operation time of 9.34 min. (3) Results: The minimal interval from surgery to return to regular activities was 13.26 (range 7 to 22) days. Recurrence and postoperative wound infections were found in 3 (3.95%) and 2 (2.63%) patients, respectively. Evaluation of patient satisfaction at one-year follow-up showed that 40 (52.63%) patients were very satisfied, 33 (43.42%) were satisfied, 3 (3.95%) were dissatisfied, and none of them were very dissatisfied. The average follow-up duration was 14.66 (range 12 to 25) months. (4) Conclusions: Therefore, it is believed that this less-invasive and simple procedure could be easily performed by clinicians, with satisfactory patient outcomes.
Ingrown toenail, also called onychocryptosis, is a common disorder involving big toes. Although considered a relatively minor foot ailment, ingrown toenail causes severe toe pain when walking, and eventually limits routine daily activities [1, 2]. Besides, if a patient has diabetes mellitus, ingrown toenail can deteriorate into a diabetic foot ulcer and induce chronic osteomyelitis of the involved limb [3]. Therefore, adequate management of ingrown nails is crucial.
Nail Bed Tumour (subungual Glomus Tumour) Excision And #nailaesthetics |
In the early stages, ingrown toenails can be managed successfully via nonsurgical methods including foot care (avoiding ill-fitting footwear and soaking in warm water), topical oral antibiotics, proper nail trimming and elevation of nail corner. However, operative intervention is required if conservative treatment fails or the toenail is accompanied by seropurulent drainage or chronic inflammation [4, 5].
Among the various surgical treatments for ingrown toenail, the Winograd method is a popular technique that has been used frequently since 1927, and entails partial nail plate excision and curettage of nail bed and germinal matrix [1]. In an effort to avoid recurrence, such minimally invasive procedures have been modified over the years to include wedge resection of the nail fold and complete ablation of germinal matrix via chemical or electrical matrixectomy [1, 6, 7, 8, 9]. However, based on a review of previous studies, poor postoperative outcome related to delayed wound healing and recurrence rate have been detected in wedge resection procedures [6].
Therefore, we postulated that wedge resection of the germinal fold, a relatively invasive procedure, could be more harmful than beneficial. The original Winograd method for partial excision of only the nail plate is of interest.
Nail Avulsion And Matrixectomy
In the present study, we combined the original Winograd procedure with matrixectomy using electrocoagulation in patients with ingrown toenail. We retrospectively reviewed the data showing the recurrence rate, post-operative infection rate, surgical duration, the time required to return to regular activities, and patient satisfaction.
We retrospectively analyzed and compared the outcomes of patients. The purpose of this study was to evaluate the patients who underwent surgery for ingrown toenail at a university hospital for two years from November 2015 to October 2017. On 29 April 2020, this study was approved by the Ethics Committee of Chuncheon Sacred Heart Hospital, Hallym University (Institutional Review Board number: CHUNCHEON 2020-04-006).
Sixty-nine patients underwent surgical treatment for ingrown toenail by one surgeon. The patients included 7 cases with ingrown toenails on both feet and each foot was counted separately. Patients who underwent previous surgery for ingrown toenail were excluded. A total of 76 great toes were treated surgically. Preoperative Heifetz staging revealed 68 cases of stage 2 and 8 cases of stage 3. The patient was referred to the hospital for dressing change the day after surgery, and sutures were removed about 2 weeks after surgery. A follow-up phone call 1 year after the surgery was conducted to determine the recurrence and the degree of satisfaction. Patient satisfaction was categorized as follows: very satisfied, satisfied, dissatisfied, and very dissatisfied [7]. We recorded the operative time, the time required to return to regular activities and the incidence of postoperative infection. We defined recurrence as evidence of (1) ingrown nail edge, (2) spicule formation from the germinal matrix, and (3) recurrence of previous symptoms [8].
Ingrown Toenails: Current Procedures To Treat Acute And Chronic Problems— Steps To Prevent Recurrence
Surgical treatment was performed by a single surgeon. Thirty minutes before the operation, 1 g of cefazolin was injected intravenously, and after the surgery, the first-generation cephalosporin was administered orally. Adjunctive antibiotic use was limited to the patients with definite infection signs including substantial erythema or purulent drainage. The patient was placed on the operating table. To induce local anesthesia, a digital nerve block was performed at the base of the affected big toe using 1% lidocaine solution. The rubber band tourniquet was applied at the base of the toe. A small incision (less than 10 mm) was made at the eponychium along the line of expected nail excision, followed by a gentle, blunt dissection with the Freer elevator to separate the soft tissue from the ingrown portion of the nail. After the dissection, a partial excision (a quarter to one-fifth) nail plate was performed with a small scissor. Using a surgical curette, the germinal matrix and nail bed were scraped off and destroyed. The granulation tissue at the lateral margin of the nail plate was incised using a scalpel without resection of the lateral nail fold. The germinal matrix and nail bed were destroyed via electrocautery in coagulation mode for a total of 3 to 4 s. After copious irrigation, one nylon suture was applied to attach the resected eponychium. In case of unstable nail plate following the gentle, blunt dissection of the soft tissue, additional distal suture was made to stabilize the nail plate. (Figure 1).
The 76 cases included 40 (52.63%) males and 36 (47.37%) females with a mean age of 41.18 years (range 12 to 85). The mean operation time was 9.34 min, without any surgical complications.
The minimal interval from surgery to return to regular activities was 13.26 (range 7 to 22) days. The follow-up of patients at one year revealed that 40 (52.63%) were very satisfied, 33 (43.42%) were satisfied, 3 (3.95%) were dissatisfied, and none were very dissatisfied. The altered rate of satisfaction was attributed to postsurgical pain due to residual scar. Recurrence was observed in 3 (3.95%) patients and postoperative wound infection was found in 2 (2.63%) cases. Lastly, the average follow-up duration was 14.66 (range 12 to 25) months (Table 1).
Ingrown Toenail Treated By The Modified Howard–dubois Technique: Long Term Follow Up Results
Unless the ingrown nail is limited to early inflammation, operative treatment is indicated in many cases. Among a variety of surgical methods, the ideal procedure should result in a low recurrence rate, have a short interval of return to regular activity, and be easy to perform [5, 9, 10]. In the current study, recurrence and infection rates were relatively low at 3.95% and 2.63%, respectively. Further, the time to return to regular activity was short, and the surgical technique was relatively easy as no additional nail fold resection was performed.
The symptoms of ingrown toenail manifest when the paronychium is in contact with the lateral tip spicule of the nail plate, which causes irritation and reaction to a foreign body that eventually lead to inflammation [10, 11]. In an effort to avoid skin irritation by the nail plate, special suture techniques were used to lay the skin under the nail after wedge resection, which actually reduced the recurrence rate [10, 11]. Furthermore, in order to radically remove the inflammatory granulation tissue formed by repetitive irritation of the lateral fold, wedge resection of the nail fold has been widely reported in
In the present study, we combined the original Winograd procedure with matrixectomy using electrocoagulation in patients with ingrown toenail. We retrospectively reviewed the data showing the recurrence rate, post-operative infection rate, surgical duration, the time required to return to regular activities, and patient satisfaction.
We retrospectively analyzed and compared the outcomes of patients. The purpose of this study was to evaluate the patients who underwent surgery for ingrown toenail at a university hospital for two years from November 2015 to October 2017. On 29 April 2020, this study was approved by the Ethics Committee of Chuncheon Sacred Heart Hospital, Hallym University (Institutional Review Board number: CHUNCHEON 2020-04-006).
Sixty-nine patients underwent surgical treatment for ingrown toenail by one surgeon. The patients included 7 cases with ingrown toenails on both feet and each foot was counted separately. Patients who underwent previous surgery for ingrown toenail were excluded. A total of 76 great toes were treated surgically. Preoperative Heifetz staging revealed 68 cases of stage 2 and 8 cases of stage 3. The patient was referred to the hospital for dressing change the day after surgery, and sutures were removed about 2 weeks after surgery. A follow-up phone call 1 year after the surgery was conducted to determine the recurrence and the degree of satisfaction. Patient satisfaction was categorized as follows: very satisfied, satisfied, dissatisfied, and very dissatisfied [7]. We recorded the operative time, the time required to return to regular activities and the incidence of postoperative infection. We defined recurrence as evidence of (1) ingrown nail edge, (2) spicule formation from the germinal matrix, and (3) recurrence of previous symptoms [8].
Ingrown Toenails: Current Procedures To Treat Acute And Chronic Problems— Steps To Prevent Recurrence
Surgical treatment was performed by a single surgeon. Thirty minutes before the operation, 1 g of cefazolin was injected intravenously, and after the surgery, the first-generation cephalosporin was administered orally. Adjunctive antibiotic use was limited to the patients with definite infection signs including substantial erythema or purulent drainage. The patient was placed on the operating table. To induce local anesthesia, a digital nerve block was performed at the base of the affected big toe using 1% lidocaine solution. The rubber band tourniquet was applied at the base of the toe. A small incision (less than 10 mm) was made at the eponychium along the line of expected nail excision, followed by a gentle, blunt dissection with the Freer elevator to separate the soft tissue from the ingrown portion of the nail. After the dissection, a partial excision (a quarter to one-fifth) nail plate was performed with a small scissor. Using a surgical curette, the germinal matrix and nail bed were scraped off and destroyed. The granulation tissue at the lateral margin of the nail plate was incised using a scalpel without resection of the lateral nail fold. The germinal matrix and nail bed were destroyed via electrocautery in coagulation mode for a total of 3 to 4 s. After copious irrigation, one nylon suture was applied to attach the resected eponychium. In case of unstable nail plate following the gentle, blunt dissection of the soft tissue, additional distal suture was made to stabilize the nail plate. (Figure 1).
The 76 cases included 40 (52.63%) males and 36 (47.37%) females with a mean age of 41.18 years (range 12 to 85). The mean operation time was 9.34 min, without any surgical complications.
The minimal interval from surgery to return to regular activities was 13.26 (range 7 to 22) days. The follow-up of patients at one year revealed that 40 (52.63%) were very satisfied, 33 (43.42%) were satisfied, 3 (3.95%) were dissatisfied, and none were very dissatisfied. The altered rate of satisfaction was attributed to postsurgical pain due to residual scar. Recurrence was observed in 3 (3.95%) patients and postoperative wound infection was found in 2 (2.63%) cases. Lastly, the average follow-up duration was 14.66 (range 12 to 25) months (Table 1).
Ingrown Toenail Treated By The Modified Howard–dubois Technique: Long Term Follow Up Results
Unless the ingrown nail is limited to early inflammation, operative treatment is indicated in many cases. Among a variety of surgical methods, the ideal procedure should result in a low recurrence rate, have a short interval of return to regular activity, and be easy to perform [5, 9, 10]. In the current study, recurrence and infection rates were relatively low at 3.95% and 2.63%, respectively. Further, the time to return to regular activity was short, and the surgical technique was relatively easy as no additional nail fold resection was performed.
The symptoms of ingrown toenail manifest when the paronychium is in contact with the lateral tip spicule of the nail plate, which causes irritation and reaction to a foreign body that eventually lead to inflammation [10, 11]. In an effort to avoid skin irritation by the nail plate, special suture techniques were used to lay the skin under the nail after wedge resection, which actually reduced the recurrence rate [10, 11]. Furthermore, in order to radically remove the inflammatory granulation tissue formed by repetitive irritation of the lateral fold, wedge resection of the nail fold has been widely reported in
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