Ingrown nail surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Surgery and Device Based Therapy [1]

Phenolisation[2] [3] is a method that can be employed to help heal an ingrown nail. Following injection of a local anesthetic at the base of the toenail and perhaps application of a tourniquet, the surgeon will remove (ablate) the edge of the nail growing into the flesh. He will then destroy the matrix area with phenol to permanently and selectively ablate the matrix that is manufacturing the ingrown portion of the nail (i.e., the nail margin). This is known as a partial matrixectomy, phenolisation, phenol avulsion or partial nail avulsion with matrix phenolisation. Also, any infection is surgically drained. After this date, other suggestions on aftercare will be made, such as salt water bathing of the digit in question. The point of the procedure is that the nail does not grow back where the matrix has been cauterized and so the chances of further ingrowth are very low. The nail is slightly (usually one millimeter or so) narrower than prior to the procedure and is barely noticeable one year later. The surgery is advantageous because it can be performed in the doctor's office under local anesthesia with minimal pain following the intervention. Also, there is no visible scar on the surgery site and a nominal chance of recurrence. The procedure will fail in about 2 to 3 times out of a hundred.

A wedge resection is a partial removal of the nail or an offending piece of nail. It is more complex than a complete nail avulsion (removal). Here, the digit is first injected with a common local anesthetic. When the area is numb, the physician will perform an onychotomy in which the nail along the edge that is growing into the skin is cut away (ablated) and the offending piece of nail is pulled out. Any infection is surgically drained. This process is referred to as a wedge resection or simple surgical ablation and is non-permanent (i.e., the nail will re-grow from the matrix). The entire procedure may be performed in a physician's office and takes approximately thirty to forty-five minutes depending on the extent of the problem.

It should be noted that some physicians will not perform a complete nail avulsion (removal) under any but the most extreme circumstances. In most cases, these physicians will remove both sides of a toenail (even if one side is not currently ingrown) and coat the nail matrix on both of those sides with a chemical or acid (usually phenol) to prevent re-growth. This leaves the majority of the nail intact, but ensures that the problem of ingrowth will not re-occur.

There are some disadvantages in performing a wedge resection. 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. Also, the underlying condition can still become symptomatic as the nail grows out over the course of up to a year: the nail matrix might be manufacturing a nail that is simply too curved, thick, wide or otherwise irregular to allow for normal growth. Furthermore, the flesh can be injured very easily by concussion, tight socks, quick twisting motions while walking or just the fact 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 highly successful phenolisation.

CO2 laser surgery is another surgical procedure that can be used to treat an ingrown nail. Following injection of a local anesthetic at the basis of the toe and perhaps application of a small tourniquet, the surgeon will remove (ablate) the edge of the nail growing into the flesh and cauterize the matrix area by laser photocoagulation. This too is known as a partial matrixectomy or partial nail avulsion. The point of the procedure is that the nail does NOT grow back where the matrix has been cauterized and so the chances of further ingrowth are very low. The nail is slightly (usually one millimeter or so) narrower than prior to the procedure.

There are a few disadvantages to CO2 laser surgery in that sutures are usually necessary, and there is post-operative pain due to the wound and scar.

A nail avulsion (removal) is an extreme option for fixing an ingrown nail. While in some similar cases patients may wish to have the offending nail completely temporarily removed (avulsion), this procedure is not recommended by nail experts because the postoperative period is long and painful. Furthermore, complete removal of a whole nail does not always prevent recurrences. In case of recurrence in spite of complete removal, and if the patient never feels any pain before inflammation occurs, the condition is more likely to be onychia which is often confused for an ingrown or ingrowing nail (onychocryptosis).

Complete removal of a whole nail is a simple procedure. Here, anesthetic is injected, the nail is removed quickly and painlessly and the patient can leave immediately. The entire procedure can be performed in around 10 minutes and is much less complex than a wedge resection. The nail will grow back. However, in most cases it will cause further problems because it can become ingrown very easily as the nail grows outward. It can become easily injured by concussion and in some cases grows back too thick, too wide or deformed. This procedure can thus result in chronic ingrown nails and is therefore considered a generally unsuccessful solution, especially considering the pain involved.

Accordingly, in some cases as determined by a doctor, the nail matrix is coated with a chemical (usually phenol) so none of the nail will ever grow back. This is known as a permanent or full nail avulsion, or full matrixectomy, phenolisation, or full phenol avulsion. As can be seen in the images below, the nail-less toe looks much like a normal toe and fake nails or nail varnish can still be applied to the area.

Toe healing process after nail removal.
Toe healing process after nail removal.

Post-Operative Management

For a Wedge resection, the patient is allowed to go home immediately and the recovery time is anywhere from a few days to a week barring any complications such as infection. As a followup, a physician may prescribe an oral or topical antibiotic or a special soak to be used for approximately a week after the surgery.


  1. Rounding C, Bloomfield S (2005). "Surgical treatments for ingrowing toenails". Cochrane Database of Systematic Reviews (Online) (2): CD001541. doi:10.1002/14651858.CD001541.pub2. PMID 15846620. Retrieved 2012-08-06.
  2. Kominsky SJ, Daniels MD (2000). "A modified approach to the phenol and alcohol chemical partial matrixectomy". Journal of the American Podiatric Medical Association. 90 (4): 208–10. PMID 10800276. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  3. Boberg JS, Frederiksen MS, Harton FM (2002). "Scientific analysis of phenol nail surgery". Journal of the American Podiatric Medical Association. 92 (10): 575–9. PMID 12438504. |access-date= requires |url= (help)

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