View source for Ingrown toenail removal

==Background==
{{Fingertip anatomy}}

==Indications==
*Advanced [[ingrown toenail|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===
''Removing the entire outside portion of affected nail (definitive treatment)''
*Lift the affected side (up to 1/3 of the nail) off of the nail bed via blunt dissection with a hemostat
*Grasp the nail fragment with the hemostat and use a rotating motion with the clamped hemostat toward the remaining nail to expose the outside portion of the lunula
**The lateral portion of the lunula looks like a "dolphin's tail"; do not p
*Cut the nail with scissors or a nail anvil, distal to proximal, parallel to nail wall, with care not to injure the eponychium

===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==
*[[Ingrown toenail]]

==References==
<References/>

[[Category:Procedures]]