Surgical pearl: nail edge separation with dental floss for ingrown toenails

Abstract

T he ingrown nail is a common disorder that occurs most frequently in the great toe. It may be caused by wearing improperly fitting shoes and by improper trimming of the nail at the lateral edges.1 In the beginning, the patient notes discomfort, but inflammation is still minimal. With time, the offending nail edge cuts through the epidermis of the lateral groove, causing inflammation. Soon, granulation tissue develops that oozes, bleeds easily, and tends to become infected. Many treatments such as nail edge separation, partial matrix phenolization, wedge resection, and complete or partial simple toenail avulsion have been described for ingrown nails.2,3 However, these surgical therapeutic modalities have many disadvantages, such as an irregular wound healing period, the production of an unsightly nail, frequent relapse, or the restriction of normal activities. Recently, several authors have stressed the value of conservative treatments for ingrown toenails at the early stage.4,5 We applied a new noninvasive approach with dental floss to patients at the early stage. Without local anesthesia, a string of dental floss is inserted obliquely under the ingrown nail corner and pushed proximally (Fig 1). The lateral edge of the nail plate, including the spicule, is covered and separated with it (Fig 2). No restriction is placed on normal activities while it is in place. If the dental floss comes off or gets dirty in normal activities, it is replaced. Otherwise we leave it as it is until the lateral anterior tip of the nail plate reaches the hyponychium. In addition,