Does the Type of Surgical Technique and the Use of Prophylactic Antibiotics Affect the Clinical Results in Symptomatic Ingrown Toenail Patients?

Ingrown toenails are a common reason for referral to orthopedics and podiatry clinics. Recurrence and infection are common complications in ingrown toenail surgery. This study investigates the effect of an electrocautery matrixectomy on the recurrence and clinical outcomes in the Winograd technique applied in ingrown toenail surgery and whether prophylactic antibiotic use is necessary for these surgeries. One hundred forty-three patients who underwent surgery for ingrown toenails were analyzed retrospectively. Eighty-two patients underwent the Winograd procedure with electrocautery matrixectomy, whereas 61 patients underwent the Winograd procedure. While 78 patients were given prophylactic antibiotics, 65 patients were not. Patient satisfaction was evaluated with a surgical satisfaction questionnaire (SSQ). A visual analog score was used to evaluate the pain. Recurrence was observed in 3 toenails in the Winograd and electrocautery groups, while recurrence was observed in 9 toenails in the Winograd group ( P = .018). In both groups, there was no statistically significant difference between the infection rates between patients who took antibiotics and those who did not ( P > .05). There was no statistically significant difference between the groups in terms of SSQ scores ( P > .05). It was observed that the surgery performed had a positive effect on pain, and this effect was statistically highly significant in both groups ( P < .05). The outcomes of the present study suggest that the addition of an electrocautery matrixectomy to the Winograd technique in the surgical treatment of symptomatic Ingrown toenails may decrease recurrence rates. Additionally, this study showed that oral antibiotics, when used in addition to Ingrown toenail surgery, do not reduce postoperative morbidity.

Comparison of Vandenbos procedure or Winograd method for ingrown toenail

Objectives: This study aims to compare the outcomes of the Winograd method and Vandenbos procedure used to treat an ingrown toenail. Patients and methods: Between January 2017 and February 2020, a total of 145 patients (65 males, 80 females; mean age: 31.45 years; range, 13 to 61 years) who were treated with Winograd or Vandenbos procedure for an ingrown toenail were retrospectively analyzed. Of the patients, 70 underwent the Winograd method (Group 1) and 75 underwent the Vandenbos procedure (Group 2). Postoperative Visual Analog Scale (VAS) scores, demographic data, recurrence/complication rates, and satisfaction of patients were recorded. Results: The mean recovery time was 11.8±2.6 days in Group 1 and 18.0±2.1 days in Group 2 (p<0.001). The mean VAS score was 3.9±0.7 in Group 1 and 7.2±1.0 in Group 2 (p<0.001) during the first postoperative week. Of the patients, 56 (80%) of 70 patients in Group 1 and 74 (98%) of 75 patients in Group 2 were satisfied with the surgery (p<0.001). In terms of cosmetics, 60 (85%) of the patients in Group 1 and 74 (98%) of the patients in Group 2 were satisfied (p=0.003). Recurrence was observed in 10 (14%) patients in Group 1, while no recurrence was observed in Group 2. Six (8.7%) patients in Group 1 and one (1.3%) patient in Group 2 developed complications. Conclusion: Low recurrence rates, high satisfaction, and good cosmetic results can be achieved with the Vandenbos procedure, while recovery time and return to work are faster with the Winograd method. The appropriate surgical technique should be selected based on the individual patient.

Relapses of ingrown toenail: causes and treatment features

Introduction. The recurrent course of an ingrown toenail remains a serious problem to this day, despite the centuries-old history of its study. Among outpatient patients, the incidence of this disease reaches 10% and does not tend to decrease, and among the population, the incidence of ingrown toenail is 3.4%. The aim of the work was to study the causes of recurrent ingrown toenail and the effectiveness of using a laser beam in the treatment of this pathology.Material and methods. The authors analyzed the causes of recurrent ingrown toenail in 66 patients after various surgical interventions for the period from 1990 to 2020.Results and discussion. The following causes of relapse of the disease were identified: removal of the entire nail plate not according to indications, carrying out marginal resection of the nail on the affected side with the preservation of the nail plate matrix, performing removal of granulations in the nail roller area with the preservation of the nail, underestimating the importance of anti-inflammatory drug treatment in the postoperative period, as well as the importance of correcting metabolic processes in patients with concomitant pathology. A clinical case is presented: a patient with a non-healing wound after four surgeries due to an ingrown toenail with a recurrent course. The patient underwent a Schmiden surgery with resection of the “ingrown edge” of the right first toe nail and removal of infected granulations using laser irradiation of the wound and careful treatment of the matrix area in the projection of the removed part of the nail. In the postoperative period, bandages with ointment based on chloramphenicol and methyluracil were used for local treatment. Recovery occurred on the fourteenth day.Conclusion. In order to reduce the number of relapses of the disease, it is recommended to perform a matrixectomy of the bed of the removed nail plate using laser or radio wave radiation.

Ultrasound-Guided Popliteal Nerve Block with Short-Acting Lidocaine in the Surgical Treatment of Ingrown Toenails

Background: Digital nerve block (DB) is a commonly utilized anesthetic procedure in ingrown toenail surgery. However, severe procedure-related pain has been reported. Although the popliteal sciatic nerve block (PB) is widely accepted in foot and ankle surgery, its use in ingrown toenail surgery has not been reported. Therefore, this study aimed to investigate the safety and effectiveness of PB in the surgical treatment of ingrown toenails. Methods: One-hundred-ten patients surgically treated for an ingrown toenail were enrolled. Sixty-six patients underwent DB, and 44 underwent PB. PB was performed under ultrasound-guidance via a 22-gauge needle with 15 mL of 1% lidocaine in the popliteal region. The visual analogue scale was used to assess pain at two-time points: pain with skin penetration and pain with the solution injection. Time to sensory block, duration of sensory block, need for additional injections, and adverse events were recorded. Results: PB group demonstrated significantly lower procedure-related pain than the DB group. Time to sensory block was significantly longer in the PB group (20.8 ± 4.6 versus 6.5 ± 1.6 minutes). The sensory block duration was significantly longer in the PB group (187.9 ± 22.0 versus 106.5 ± 19.1 minutes). Additional injections were required in 16 (24.2%) DB cases, while no additional injections were required in PB cases. Four adverse events occurred in the DB group and two in the PB group. Conclusion: PB was a less painful anesthetic procedure associated with a longer sensory block duration and fewer repeat injections compared with DB. The result of this study implicates that PB can be an alternative anesthetic option in the surgical treatment of ingrown toenails.

Ingrown Toenail Management

Ingrown toenails are a common condition in general medicine and dermatology, and they occur when the nail curves inward and pierces the nail fold. Symptoms include pain in the affected toe, erythema and edema. The diagnosis is made clinically and, if left untreated, ingrown toenails can lead to infections and even cellulitis and osteomyelitis. Conservative treatments involve clipping on the spicule and topical antibiotics. However, the mainstay of treatment is matricectomy to reduce the recurrence rate. The risk of ingrown toenail development can be reduced by wearing proper footwear, keeping toenails cut straight and overall foot hygiene. Ingrown toenails can affect various patient populations but are more prevalent in males, young adolescents and pregnant patients. Risk factors include obesity, diabetes, improper toenail clipping and improper footwear. This review explores the clinical manifestations of ingrown toenails, along with their diagnosis and treatment, providing a concise review for physicians to accurately identify and effectively treat patients with ingrown toenails or their resultant complications.

A fast and effective solution for ingrown toenail: Creation of a 2-mm space between tissue and nail by sutureless lateral longitudinal excision

Nails have both functional and aesthetic importance. Undertreatments cause frequent recurrences affecting its functionality, while over-treatment spoils the aesthetic view. To describe the most practical and aesthetic method to treat ingrown toenail. All patients with ingrown toenail who applied to outpatient clinics of General Surgery Department between 2013 and 2019 were enrolled. A 2-mm space between tissue and nail by lateral longitudinal excision was created with only minimal matricectomy, under local anaesthesia. A total of 2334 surgical procedures were performed in 2118 patients. Recurrence rate was 1.7% during 36-month follow-up, most (70.7%) in younger men (22 years). The location of the lesions (right/left, medial/lateral or bilateral) did not show difference (p > 0.05 for each). Predisposing factors were tight-fitting footwear (4.5%), incorrect nail-trimming (3%), genetic tendency (2.8%), obesity (2.1%) and trauma (0.75%); but each was p > 0.05. Mean operation time was 3 min. There was no important complication, except hematoma (0.89%) and infection (0.68%). Mean healing time was 10 days and patients returned to daily activities in 3 days. Longitudinal excision with minimal matricectomy technique provides all dead tissue and diseased parts of nail and soft tissue to be removed. It is simple, cost-effective, satisfactory and aesthetic. SBU/23.01.2019/B.10.1.TKH.4.34.H.GP.0.01/7 (retrospectively registered).