Ingrown toenail removal

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

Partial nail removal

Removing the entire lateral or medial 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
• 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