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

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.

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