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  • • 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.


  • • 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.

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 ...

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