Ingrown Nail Onychocryptosis

The great toe's lateral and distal nail beds are the most common locations for ingrown nails. Poorly fitting shoes, poor nail-trimming techniques, and trauma can result in their formation. Most ingrown nails respond to conservative local treatment of warm soaks and elevation of the distal nail with cotton to allow unobstructed nail growth. If poor toenail trimming is the cause, a shard of nail is impaling the distal lateral nail groove and can be simply trimmed and removed for resolution of pain with standard curved or straight iris scissors.

When conservative measures fail, a partial or complete nail excision is performed to remove the portion of offending nail. The digit is prepared and a digit block placed using

1% lidocaine. A tourniquet at the base of the toe can help with hemostasis. A nail elevator is used to separate the section of nail to be removed from the underlying nail bed down to the base of the nail and germinal matrix and from the cuticle. Once elevated, an iris or bandage scissors can be used to cut the nail longitudinally to the matrix. A straight hemostat is used to grasp the nail, and the nail is rolled laterally for removal. Hemostasis can be obtained with compression or silver nitrate. A bulky tube-gauze dressing can be placed for protection. Recurrent ingrown nails unresponsive to conservative measures can be ablated after nail removal. A phenol solution is applied to a hemostatic germinal nail matrix under the proximal nail fold for 30 to 60 seconds before neutralizing the phenol with rubbing alcohol. (See Tuggy Video: Ingrown Toenail Removal.)

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