for Surgical Treatment
• Stage I.
• Description: Focal pain, erythema, and swelling at lateral
margin of the nailbed.
• Treatment: Conservative management.
• Stage II.
• Stage III.
• 1–2% lidocaine without epinephrine.
• Alcohol pads.
• 10% povidone-iodine/antiseptic cleanser.
• Syringe with 25- or 27-gauge needle.
• Digital tourniquet.
• Sterile gauze (4 × 4).
• Sterile towel and drapes.
• Sterile cotton or petrolatum gauze.
• Nail cutter or splitter.
• Antibacterial ointment.
• Silver nitrate sticks.
• Nail file.
• Scalpel #11.
• Bleeding, which can be reduced by the use of
a tourniquet for hemostasis.
• Pain, which can be alleviated by using a digital block for anesthesia.
• Recurrence of ingrown toenail.
• Absent or abnormal regrowth of the nail, resulting from aggressive
• Use a tourniquet around the affected toe to provide
• Choose conservative treatment with oral antibiotics and warm
soaks whenever possible.
• Instruct the parents about maintaining good foot hygiene (eg,
trimming the nail transversely) and advise that the child wear loose
footwear as much as possible.
Sagittal view of the nailbed.
Stage 1 Disease
• Wash the nail groove in usual sterile fashion
using 10% povidone-iodine solution.
• Soak the foot in warm water.
• Elevate the corner of the nail.
• Demonstrate proper nail-trimming technique.
• Prescribe topical or oral antibiotics.
• For patients with more significant disease, anesthetize
the area using a digital nerve block (see Chapter 55).
• Prepare a limited sterile field using 10% povidone-iodine solution
and sterile towels.
• Place a digital tourniquet at the base of the toe to prevent excessive
bleeding during the procedure.
• Lift the affected nail edge out of the nail groove and rotate
it away from the nail fold (Figure 36–2).
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