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Ingrown Toenail Surgery

An ingrown toenail is a common, usually painful condition in which the nail grows into the skin of your toe or the skin grows over the nail.

While this can happen with any of your toes, it most commonly affects your big toe. You can usually treat ingrown toenails at home, but if they become infected, then you may need ingrown toenail removal by a medical professional. This will alleviate the condition and keep the toe from developing any more serious issues.

An ingrown nail, also known as onychocryptosis from Greek: ὄνυξ (onyx) 'nail' and κρυπτός (kryptos) 'hidden', is a common form of nail disease. It is an often painful condition in which the nail grows so that it cuts into one or both sides of the paronychium or nail bed. While ingrown nails can occur in the nails of both the hands and the feet, they occur most commonly with the toenails (as opposed to fingernails), and for the most part are only problematic and painful on the big toe. A common conception is that the nail enters into the paronychium, but an "ingrown toenail" can simply be overgrown toe skin. The condition starts first from a microbial inflammation of the paronychium, and then a granuloma, which results in a nail buried inside of the granuloma. A true ingrown toenail is caused by actual penetration of flesh by a sliver of toenail.

Types of Procedure

Wedge resection
This procedure 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 outpatient clinic in approximately thirty to forty-five minutes depending on the extent of the problem.

Avulsion procedure
In case of recurrence after complete removal, and if the patient never felt any pain before inflammation occurred, the condition is more likely to be onychia which is often confused for an ingrown or ingrowing nail (onychocryptosis). Complete removal of the whole nail is a simple procedure. Anaesthetic is injected and the nail is removed quickly by pulling it outward from the toe.

Vandenbos procedure
The Vandenbos procedure was first described by Vandenbos and Bowers in 1959, the procedure does not touch the nail. In this procedure, the affected toe is anesthetized with a digital block and a tourniquet is applied. An incision is made proximally from the base of the nail about 5 mm (leaving the nail bed intact) then extended toward the side of the toe/toenail in an elliptical sweep to end up under the tip of the nail about 3-4 mm in from the edge. It is important that all the skin at the edge of the nail be removed. The excision must be adequate leaving a soft tissue deficiency measuring 1.5 x 3 cm. A portion of the lateral aspect of the distal phalanx is occasionally exposed without fear of infection. Antibiotics are not necessary as the wound is left open to close by secondary intention.