Surgical Treatment of Ingrown Toenails
Surgical treatments of ingrown toenails include a number of different options. If conservative treatment of a minor ingrown toenail does not succeed or if the ingrown toenail is severe, surgical management by a podiatrist is recommended. The initial surgical approach is typically a partial avulsion of the nail plate known as a wedge resection or a complete removal of the toenail.If the ingrown toenail recurs despite this treatment, destruction of the germinal matrix with phenol is recommended.Antibiotics are not needed if surgery is performed.
If the nail becomes ingrown again after a wedge resection, more invasive surgery may be needed, although this rather drastic measure may not be necessary: less invasive repeat treatments such as destruction of the nail bed, should be considered. This surgery takes longer than the minor wedge resection. The toe is torniqued and incisions made from the front of the toe to around 1 cm behind the rear of the visible part of the nail. These incisions are quite deep and will require stitching and will also scar. The nail will then be cut out, much like a wedge resection and the nail bed will be broken to prevent regrowth. The nail will be significantly narrower and may appear visibly deformed but will not become ingrown again.
The physician will perform an onychectomy in which the nail along the edge that is growing into the skin is cut away (ablated) and the offending piece of nail is pulled out. Any infection is surgically drained. This process is referred to as a “wedge resection” or simple surgical ablation and is not permanent (i.e., the nail will re-grow from the matrix). The entire procedure may be performed in a physician’s office in approximately thirty to forty-five minutes depending on the extent of the problem. The patient is allowed to go home the same day and the recovery time is anywhere from two weeks to two months barring any complications such as infection. As a follow-up, a physician may prescribe an oral or topical antibiotic or a special soak to be used for about a week after the surgery.