Ingrown Toenail Surgery?
Ingrowing toenails, where conservative treatment has failed.
Partial nail avulsion and chemical matricectomy relieve symptoms and prevent regrowth of the nail edge or recurrence of the ingrowing toenail.
Ingrowing toenails are a common problem and occur when the edge of the nail grows into flesh at the side of the nail, causing a painful injury. The punctured skin can become inflamed and infected. Ingrown toenails can be classified into three stages (see Figure 1):
- mild (or Stage I) – oedema, erythema and pain
- moderate (or Stage II) – inflammation and inflection with or without purulent discharge, in addition to the symptoms of stage I
- severe (or Stage III) – chronic inflammation, epithelialised hypertrophic granulation tissue.
|Figure 1. Three stages of ingrown toenails |
Source: Eekhof JA, Van Wijk B, Knuistingh Neven A, van der Wouden JC. Interventions for ingrowing toenails. The Cochrane Database of Systematic Reviews 2012;4:CD001541.
Surgical interventions are commonly performed for patients in Stages II and III, and are more effective than non-surgical interventions in preventing the recurrence of an ingrowing toenail.
The addition of chemical cauterisation (most commonly with phenol) at Stages II and III, may be more effective in preventing recurrence and regrowth of the ingrowing toenail than surgery alone.
Diminished vascular supply to the digit is a relative contraindication to nail surgery.
Overt bacterial infection of the operative site is a relative contraindication to chemical cauterisation. Treatment with a systemic antibiotic for two to three weeks before performing the procedure may be required.
Potential factors to consider:
- Infection/inflammation can reduce the effect of the local anaesthetic in a toe.
- Phenol is classified as ‘hazardous’ according to Safe Work Australia.
- Phenol is systemically absorbed following application to the skin, and has been shown to have fetotoxic effects in animal studies.
Use caution with people who have a bleeding disorder or who are taking anticoagulant therapy.
Pain is the most common complication following nail surgery and is more likely to occur when infection is present before the procedure.
Even with meticulous patient preparation and technique, postoperative infection may occur. Infection within the first few days postoperatively is likely to be bacterial (usually Staphylococcus aureus). However, infections occurring after a week may be fungal (usually Candida).
Seeking Treatment For Ingrown Toenail Surgery
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