Refinements in Surgical Wedge Resection for the Ingrown Toenail

Abstract

Ingrown toenails with clinical painful symptoms or personal discomfort may result in missing time from school, work and sports. This condition usually misdiagnosed as paronychia and managed with a simple strip or total nail avulsion (removal of the nail plate) in outpatient visit. However, this treatment has high recurrence rate and should therefore not be used as a routine practice. The definite treatments for the ingrown toenails are removal of the affected nail forming tissue surgically and/or destroy it by chemical agent or electric cauterization. The aim of this article is to present our experiences in improving the surgical results when the wedge excision is used for the patients with ingrown toenails. After 28 treated sites in 21 patients, we refined the surgical technique to get more reliable, predictable surgical results. The potential pocket which was created by the lateral corner of the nail root was opened by a small elevator. The full extent of the nail-forming tissue was stained by methylene blue. The ingrowing nail-forming tissue could be removed completely under this guidance. The following 47 patients with 63 treated sites were treated with this refined technique. Follow up 6-24 months (mean 9.5) and recorded the normal footwear time, wound healing, complication or infection, recurrent nail spikes, finally the cosmetic results. The recurrence rate was decreased significantly (from 14.3% to 1.8%). Surgical anatomy is emphasized in the presentation of refinements.