A Minimally-Invasive, Simple, Rapid, and Effective Surgical Technique for the Treatment of Ingrown Toenails: A Reminder of the Original Winograd Procedure.

Jahyung Kim,Sung Hun Won,Young Yi,Dong Il Chun,Jaeho Cho,Sanghyeon Lee,Jeong Seok Lee

doi:10.3390/ijerph18010278

Abstract

(1) Background: Ingrown toenail is a common disorder of the toe that induces severe toe pain and limits daily activities. The Winograd method, the most widely used operative modality for ingrown toenails, has been modified over years to include wedge resection of the nail fold and complete ablation of the germinal matrix. We evaluated the outcomes of original Winograd procedure without wedge resection with electrocautery-aided matrixectomy. (2) Methods: We retrospectively analyzed the outcomes of patients who underwent surgery for ingrown toenails at a university hospital for two years from November 2015 to October 2017. Surgery was performed in 76 feet with a mean operation time of 9.34 min. (3) Results: The minimal interval from surgery to return to regular activities was 13.26 (range 7 to 22) days. Recurrence and postoperative wound infections were found in 3 (3.95%) and 2 (2.63%) patients, respectively. Evaluation of patient satisfaction at one-year follow-up showed that 40 (52.63%) patients were very satisfied, 33 (43.42%) were satisfied, 3 (3.95%) were dissatisfied, and none of them were very dissatisfied. The average follow-up duration was 14.66 (range 12 to 25) months. (4) Conclusions: Therefore, it is believed that this less-invasive and simple procedure could be easily performed by clinicians, with satisfactory patient outcomes.

Highlights

Ingrown toenail, called onychocryptosis, is a common disorder involving big toes
The time to return to regular activity was short, and the surgical technique was relatively easy as no additional nail fold resection was performed
The symptoms of ingrown toenail manifest when the paronychium is in contact with the lateral tip spicule of the nail plate, which causes irritation and reaction to a foreign body that eventually lead to inflammation [10,11]

Summary

Introduction

Called onychocryptosis, is a common disorder involving big toes. Considered a relatively minor foot ailment, ingrown toenail causes severe toe pain when walking, and eventually limits routine daily activities [1,2]. If a patient has diabetes mellitus, ingrown toenail can deteriorate into a diabetic foot ulcer and induce chronic osteomyelitis of the involved limb [3]. Adequate management of ingrown nails is crucial. Ingrown toenails can be managed successfully via nonsurgical methods including foot care (avoiding ill-fitting footwear and soaking in warm water), topical oral antibiotics, proper nail trimming and elevation of nail corner. Operative intervention is required if conservative treatment fails or the toenail is accompanied by seropurulent drainage or chronic inflammation [4,5]

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Discussion

Conclusion