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Continuing Medical Education

Soft-tissue nail-fold excision: a definitive treatment for ingrown toenails

Henry Chapeskie and Jason R. Kovac
CAN J SURG August 01, 2010 53 (4) 282-286;
Henry Chapeskie
* Department of Family Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, and the
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  • For correspondence: [email protected]
Jason R. Kovac
† McMaster Institute of Urology, St. Joseph’s Hospital, Hamilton, Ont
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  • Fig. 1
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    Fig. 1

    Examples of the severity of ingrown toenails surgically corrected by soft-tissue nail-fold excision. The preoperative appearance (left) highlights the extensive medial and lateral nail-fold granulation tissue. The images obtained in the postoperative period (centre, right) show the surgical site following nail-fold excision. The excision of soft tissue was typically generous and adequate, with all portions of the granulation tissue removed.

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    Fig. 2

    The soft-tissue nail-fold excision procedure for ingrown toenails. In step 1, the toe is cleansed with an iodine solution, and ring block anesthesia is applied with 2% xylocaine without epinephrine. A tight elastic tourniquet is placed at the base of the toe to maintain a clear surgical field. An initial incision of 5–10 mm is made proximally from the base of the nail and about 3–5 mm from the lateral border of the nail to encompass the proximal nail fold. Care is taken to leave the nail matrix intact. In steps 2 to 4, the lateral nail fold is excised using a lateral elliptical sweep that proceeds distally to encompass all involved granulation tissue and adjacent soft tissues. In steps 5 and 6, all skin and subcutaneous tissues at the edge of the nail is removed. Occasionally, a portion of the distal phalanx is exposed. The operative site following complete excision of soft-tissue nail folds is shown in step 7. Note the intact nail and preservation of the nail matrix. The applied tourniquet successfully minimizes bleeding in the surgical field. In step 8, electrocautery is used to obtain hemostasis, and the wound is left open to close by secondary intention following the application of gauze dressings.

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    Fig. 3

    Images showing healing by secondary intention following surgical nail-fold excision. Post-op = postoperative.

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    Fig. 4

    Postoperative recurrence (A) and patient satisfaction (B) in 124 patients (212 sites) following surgical correction of ingrown toenails using soft-tissue nail-fold excision.

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    Table 1

    Demographic characteristics of 124 patients who underwent surgical correction of ingrown toenails

    Characteristic% of patients
    Age, yr
     < 1950.8
     20–2921.7
     30–398.3
     40–499.2
     50–595.0
     > 605.0
    Sex
     Male69.4
     Female30.6
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    Table 2

    Preoperative responses of patients who underwent surgical correction of ingrown toenails

    Characteristic% of patients
    No prior treatment of the affected toe77.2
    Experienced severe pain
     Strongly agree78.8
     Neutral13.0
     Strongly disagree8.2
    Difficulty with regular footwear
     Strongly agree69.9
     Neutral10.6
     Strongly disagree19.5
    Difficulty with regular activities
     Strongly agree64.3
     Neutral12.2
     Strongly disagree23.6
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In this issue

Canadian Journal of Surgery: 53 (4)
CAN J SURG
Vol. 53, Issue 4
1 Aug 2010
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Soft-tissue nail-fold excision: a definitive treatment for ingrown toenails
Henry Chapeskie, Jason R. Kovac
CAN J SURG Aug 2010, 53 (4) 282-286;

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Soft-tissue nail-fold excision: a definitive treatment for ingrown toenails
Henry Chapeskie, Jason R. Kovac
CAN J SURG Aug 2010, 53 (4) 282-286;
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