Chapter 36. Ingrown Toenail Treatment

• • Pain relief.

  • Management of infection.

  • Prevention of recurrence.

Specific Indications for Surgical Treatment

• • Stage I.

  • • Description: Focal pain, erythema, and swelling at lateral margin of the nailbed.

    • Treatment: Conservative management.

  • Stage II.

  • • Description: Worsening inflammation and infection and formation of purulent granulation tissue.

    • Treatment: Conservative management or angular nail resection with debridement.

  • Stage III.

  • • Description: Chronic and severe disease state with lateral wall hypertrophy.

    • Treatment: Partial nail resection or total nail avulsion.

Relative

• • Underlying conditions that could complicate wound healing (eg, immunosuppression, diabetes). Referral to specialty clinics may be appropriate for patients with such conditions.

• • 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.

  • Hemostats.

  • Scissors.

  • 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 debridement.

• • Use a tourniquet around the affected toe to provide additional hemostasis.

  • 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.

• • Obtain informed consent from the parents or guardian after a full explanation of the procedure.

• • Child should sit or lie down in a comfortable position with the legs elevated to allow easy access to the affected toenail.

• • Figure 36–1 shows the sagittal view of the nailbed.

Stage 1 Disease (Most Children)

• • 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.

Stage I (Severe)

• • 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).

• • Remove ...