Ingrown toenail removal
- The perinychium includes the nail, the nailbed, and the surrounding tissue.
- The paronychia is the lateral nail folds
- The hyponychium is the palmar surface skin distal to the nail.
- The lunula is that white semi-moon shaped proximal portion of the nail.
- The sterile matrix is deep to the nail, adheres to it and is distal to the lunule.
- The germinal portion is proximal to the matrix and is responsible for nail growth.
- Advanced onychocryptosis (heavy granulation tissue, pain with walking)
- Significant granulation tissue precluding partial nail removal
- Multiple comorbidities in a patient not requiring immediate relief
- Chlorhexidine or betadine
- Syringe with 27-ga needle
- 1% lidocaine without epinephrine or 0.5% bupivacaine
- 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
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
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
- Cover with gauze, instruct to keep clean and dry, wash 2-3 times a day
- No antibiotics unless surrounding cellulitis
- Retained nail fragment