Ingrown toenail removal: Difference between revisions
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== Background | ==Background== | ||
*Lateral nail edge grows deep into nail wall | *Lateral nail edge grows deep into nail wall → cycle of inflammation and hypertrophic granulation tissue can lead to abscess | ||
*Minor cases can be treated non-surgically | |||
*Minor cases can be treated | |||
== Contraindications == | ==Indications== | ||
*Advanced onychocryptosis (heavy granulation tissue, pain with walking) | |||
==Contraindications== | |||
*Significant granulation tissue precluding partial nail removal | *Significant granulation tissue precluding partial nail removal | ||
*Multiple comorbidities in a patient not requiring immediate relief | *Multiple comorbidities in a patient not requiring immediate relief | ||
== Equipment needed == | ==Equipment needed== | ||
*Gloves | *Gloves | ||
* | *Chlorhexidine or betadine | ||
*27-ga needle | *Syringe with 27-ga needle | ||
*1% lidocaine without epinephrine | *1% lidocaine without epinephrine '''or''' 0.5% bupivacaine | ||
*Gauze | *Gauze | ||
*Thin flat hemostat | *Thin flat hemostat | ||
*Straight forceps | *Straight forceps | ||
*Iris scissors | *Iris scissors | ||
*Aqueous phenol or silver nitrate | |||
== Procedure == | ==Procedure== | ||
*Digital block using | *Perform [[Digital block]] using lidocaine without epinephrine or bupivacaine | ||
*Clean area thoroughly | *Clean area thoroughly | ||
=== Partial nail removal === | === Partial nail removal === | ||
*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 | |||
*Use forceps to help remove the corner | |||
=== Complete (lateral) nail removal === | ===Complete (lateral) nail removal=== | ||
Removing the entire lateral portion of the nail is the more definitive treatment | ''Removing the entire lateral portion of the nail is the more definitive treatment'' | ||
*Lift the lateral quarter or third of the nail off of the nail bed with a hemostat | |||
*Cut the nail with scissors or a nail anvil, distal to proximal, parallel to nail wall, with care not to injure the eponychium | |||
*Grasp the nail fragment with the hemostat and pull in a twisting motion distally and toward the remaining nail until removed | |||
*Gently debride the exposed tissue | |||
=== Matricectomy === | ===Matricectomy=== | ||
Ablating the lateral matrix can decrease recurrence | ''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 | *Cover with gauze, instruct to keep clean and dry, wash 2-3 times a day | ||
*No antibiotics unless cellulitis | *No antibiotics unless surrounding cellulitis | ||
== Complications == | ==Complications== | ||
*Recurrence | *Recurrence | ||
*Infection | *Infection | ||
| Line 52: | Line 53: | ||
*Retained nail fragment | *Retained nail fragment | ||
== | ==See Also== | ||
*[[Paronychia]] | |||
== | ==References== | ||
<References/> | |||
[[Category:Procedures]] | [[Category:Procedures]] | ||
Revision as of 07:09, 6 September 2015
Background
- Lateral nail edge grows deep into nail wall → cycle of inflammation and hypertrophic granulation tissue can lead to abscess
- Minor cases can be treated non-surgically
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
- 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
- Use forceps to help remove the corner
Complete (lateral) nail removal
Removing the entire lateral portion of the nail is the more definitive treatment
- Lift the lateral quarter or third of the nail off of the nail bed with a hemostat
- Cut the nail with scissors or a nail anvil, distal to proximal, parallel to nail wall, with care not to injure the eponychium
- Grasp the nail fragment with the hemostat and pull in a twisting motion distally and toward the remaining nail until removed
- Gently debride the exposed tissue
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