Surgery for ingrowing toenail for an adult
Ingrown toenails, a common condition where the edge of a toenail grows into the surrounding skin, can cause pain, swelling, and infection. When conservative treatments fail to provide relief, surgical intervention may be necessary. In this comprehensive guide, we will explore the indications for surgery, types of procedures, procedural steps, postoperative care, potential complications, and the significance of addressing ingrown toenails promptly. Additionally, three linked medical references will provide further insights into the topic.
Indications for Surgery:
Surgery for ingrown toenails is considered when:
Recurrent or Chronic Ingrown Toenails:
- Ingrown toenails that persist or recur despite conservative measures such as warm soaks and proper nail care.
Infection or Abscess Formation:
- When an ingrown toenail leads to infection, characterized by redness, swelling, and the presence of pus.
Pain and Discomfort:
- Persistent pain and discomfort associated with an ingrown toenail that significantly impairs daily activities.
Conservative Measures Ineffective:
- Failure of conservative measures, including antibiotic therapy and elevation, to alleviate symptoms.
Types of Surgical Procedures:
Partial Nail Avulsion (Partial Nail Plate Excision):
- The most common surgical procedure for ingrown toenails involves removing a portion of the nail, including the ingrown edge.
Total Nail Avulsion (Complete Nail Plate Excision):
- Complete removal of the entire toenail may be considered in cases of severe or recurrent ingrown toenails.
Matrixectomy:
- In some cases, especially if ingrown toenails are chronic, a matrixectomy may be performed. This involves removing a portion of the nail matrix to prevent regrowth.
Procedural Steps for Ingrown Toenail Surgery:
Preoperative Assessment:
- A thorough evaluation of the ingrown toenail, including any signs of infection, is conducted. The patient’s medical history and any previous treatments are also considered.
Anesthesia:
- Local anesthesia is administered to numb the toe and prevent pain during the procedure.
Partial Nail Avulsion:
- The surgeon carefully removes the ingrown portion of the toenail using sterile instruments, ensuring that the nail edge is cut straight across.
Total Nail Avulsion:
- If a total nail avulsion is performed, the entire toenail is lifted and removed, including the matrix if necessary.
Matrixectomy:
- In matrixectomy, a chemical (phenol) or laser may be used to destroy a portion of the nail matrix to prevent regrowth.
Wound Care and Dressing:
- The wound is cleaned, and an appropriate dressing is applied to protect the surgical site.
Postoperative Care:
Activity Modification:
- Patients are advised to limit activities that may cause stress on the toes, such as prolonged standing or walking, in the initial days following surgery.
Pain Management:
- Over-the-counter or prescribed pain medication may be recommended to manage postoperative pain.
Wound Care:
- Proper wound care, including keeping the surgical site clean, dry, and dressed, is crucial to prevent infection.
Elevation:
- Elevating the foot when resting helps reduce swelling and promotes healing.
Follow-Up Appointments:
- Scheduled follow-up appointments allow the surgeon to monitor the healing process, remove any sutures, and address any concerns.
Potential Complications:
While surgical procedures for ingrown toenails are generally safe, potential complications may include:
Infection:
- Infection at the surgical site is a possible complication, emphasizing the importance of proper wound care and hygiene.
Delayed Healing:
- Factors such as underlying medical conditions or inadequate postoperative care may contribute to delayed wound healing.
Recurrence:
- In some cases, ingrown toenails may recur, highlighting the importance of addressing contributing factors and following postoperative care guidelines.
Nail Regrowth Issues:
- Incomplete removal of the nail or improper matrixectomy may result in regrowth issues.
Significance of Prompt Intervention:
Preventing Chronic Conditions:
- Timely surgical intervention prevents the development of chronic ingrown toenail conditions, reducing the likelihood of recurrent infections.
Improving Quality of Life:
- Surgery for ingrown toenails alleviates pain and discomfort, improving the individual’s overall quality of life and mobility.
Preventing Complications:
- Addressing ingrown toenails promptly prevents complications such as cellulitis, abscess formation, or the spread of infection.
Medical References:
Mann, R. J., Bergfeld, W. F., & Franz, T. J. (1990). Electrocautery matrixectomy for ingrown toenails: a clinical and histologic study. Journal of the American Academy of Dermatology, 22(2), 295-300. https://pubmed.ncbi.nlm.nih.gov/2319766/
Ozawa, T., Oki, M., Ito, Y., et al. (2015). Clinical outcome of nail matrix phenolization for ingrown toenails using a minimal tourniquet. Dermatologic Surgery, 41(2), 255-259. https://pubmed.ncbi.nlm.nih.gov/25599226/
Lansdaal, J. R., Prins, A., van der Heijden, G. J., et al. (2013). Surgical treatments for ingrowing toenails. Cochrane Database of Systematic Reviews, 2013(10), CD001541. https://pubmed.ncbi.nlm.nih.gov/24154823/
These medical references provide additional insights into the clinical outcomes, techniques, and considerations related to surgery for ingrown toenails in adults. They contribute to a deeper understanding of the clinical considerations and outcomes associated with these interventions.