Ingrown toenail removal

From WikEM
Jump to: navigation, search


  • 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


  • Advanced onychocryptosis (heavy granulation tissue, pain with walking)


  • 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


  • 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


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


  • Recurrence
  • Infection
  • Bleeding
  • Retained nail fragment

See Also