Surgical treatment of ingrown toenails

[1] The initial surgical approach is typically a partial avulsion of the nail plate known as a wedge resection or a complete removal of the toenail.

This process is referred to as a "wedge resection" or simple surgical ablation and is not permanent (i.e., the nail will re-grow from the matrix).

The entire procedure may be performed in a physician's office in approximately thirty to forty-five minutes depending on the extent of the problem.

The patient is allowed to go home the same day and the recovery time is anywhere from two weeks to two months barring any complications such as infection.

[citation needed] Some physicians will not perform a complete nail avulsion (removal) except under extreme circumstances.

There are possible disadvantages if the nail matrix is not coated with the applicable chemical or acid (phenol) and is allowed to re-grow; this method is prone to failure.

Furthermore, the flesh can become injured by concussion, tight socks, quick twisting motions while walking, or simply because the nail is growing incorrectly (likely too wide).

This hypersensitivity to continued injury can mean chronic ingrowth; the solution is nearly always edge avulsion by the more effective procedure of phenolisation.

In case of recurrence after complete removal, and if the patient never felt any pain before inflammation occurred, the condition is more likely to be onychia which is often confused for an ingrown or ingrowing nail (onychocryptosis).

[6] In difficult or recurrent cases of onychocryptosis (ingrown toenail) the patient's symptoms persist necessitating a permanent operative solution.

The "avulsion procedure" is simple but the surgeon must be skilled enough to accomplish total destruction, and removal of, the nail matrix.

In these cases, the best method is the Syme procedure, that means total nail matrix removal + skin flap transfer + phalanx partial osteotomy + stitching.

The surgery is advantageous because it can be performed in the doctor's office under local anesthesia and recovery time is minimal.