Ingrown Nail Surgery
I discussed ingrown nails in another article, their causes, and conservative treatment. I would like to followup this discussion with surgical treatment options for this painful condition.
Any discussion of nail surgery would be incomplete without first discussing some basic anatomy. Your nail rests on skin known as the nail bed. At the base of the nail bed, one finds the nail matrix (nail root). The nail root is a pearly white area of cells that form a nail as they grow forward. It is the focus of most surgery for ingrown nails. The little white half moon at the base of the nail is known as the lunula. The thin skin fold behind the lunula is known as the eponychium or nail wall.
The simplest surgical procedure for ingrown toenails is a nail avulsion. This involves removal of only the ingrown nail border and nothing else. Although this procedure allows the quickest return to activity, there is a high recurrence rate. Often the ingrown nail will return 6 to 12 months later. A nail avulsion is usually the procedure of choice when the toe is grossly infected.
Most surgeries for ingrown nails try to remove part of the nail root, so the nail border will never grow back. A chemical burn is the most common way to achieve this goal (chemical matrixectomy). Phenol and sodium hydroxide are the chemicals most commonly used. After the surgery the patient must take good care of their open wound: daily soaks, dressing changes, antibiotic creams, or prescription creams may help heal this open wound. Healing time varies from two weeks to six weeks and is usually much quicker with younger patients.
Another way to remove the nail root is by surgical excision. After the nail border is removed an excision is extended towards the base of the toe. The nail root is literally cut out and the toe is sewn back together. At the same time a wedge excision for excessive skin on either side of the nail can be performed. Stitches are removed after 10 to 14 days. A spur on the bone underneath the nail is sometimes removed. In general, surgical excision is a little more painful and bloody for patients than a chemical burn.
Almost all ingrown nail surgery can be performed in an office setting. General anesthesia in a hospital setting is rarely needed. Anxious patients can be given oral sedation (valium) to make the experience as comfortable as possible. I like parents of young patients to help by reading a favorite book during the procedure.
Some complications of ingrown nail surgery include numbness, recurrence of the ingrown nail, scarring, pain, swelling, and infection. Sometimes a wound culture is taken for a suspected infection. Usually the procedure is not very painful and prescription pain pills are seldom required. Patients must keep follow up visits after the procedure to make sure the wound is healing well.
