Goals

To surgically remove the spicule (lateral projection of nail), with or without a portion of the nail plate, to promote normal nail growth and relieve pain and inflammation associated with moderate to severe ingrown toenail lesions.

Background

Ingrown toenails occur when a spicule of the lateral nail plate penetrates the skin of the lateral nail fold. This triggers a foreign body response characterized by inflammation and secondary infection. The great toenail is most frequently affected as a result of poorly fitting shoes, excessive trimming of the lateral nail plate, or trauma. Ingrown toenails are classified as mild to moderate or moderate to severe lesions based on the clinical signs and symptoms. Mild to moderate lesions are characterized by minimal to moderate pain, minimal erythema, and no discharge and typically respond to conservative treatment. Moderate to severe lesions are characterized by significant amounts of erythema and pus and require removal of the affected nail plate edge. Soft tissue infections are most likely caused by Staphylococcus aureus, streptococcus, and gram-negative bacteria; therefore, antibiotic treatments should provide coverage against these organisms.

Contraindications

• Bleeding dyscrasia
• Significant granulation tissue formation that would inhibit effective partial nail removal
• Allergy to local anesthetics

Use caution in the following situations:

• Diabetes
• Immunocompromised patients