Surgical treatments of ingrown toenails include a number of different options. If conservative treatment of a minor ingrown toenail does not succeed or if the ingrown toenail is severe, surgical management is recommended. The initial surgical approach is typically a partial avulsion of the lateral nail plate known as a wedge resection or a complete removal of the toenail. If the ingrown toenail reoccurs despite this treatment destruction of the germinal matrix with phenol is recommended. Antibiotics are not needed if surgery is performed.
Partial removal of the nail or an offending piece of nail. Here, the digit is first injected with a common local anesthetic. When the area is numb, the physician will perform an onychectomy 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. The patient is allowed to go home immediately and the recovery time is anywhere from a two weeks to two months barring any complications such as infection. As a follow-up, a physician may prescribe an oral or topical antibiotic or a special soak to be used for approximately a week after the surgery. Some use "lateral onychoplasty" or "wedge resection" as the method of choice, for ingrown toenails. A wide wedge resection, with a total cleaning of nail matrix, has a nearly 100% success rate. Some physicians will not perform a complete nail avulsion (removal) except under 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 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. 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 wrongly (likely too wide). This hypersensitivity to continued injury can mean chronic ingrowth; the solution is nearly always edge avulsion by the highly successful phenolisation.
Onychocryptosis (from Greek ὄνυξ onyx "nail" + κρυπτός kryptos "hidden"), also known as an ingrown toenail, or unguis incarnatus is a common form of nail disease. It is an often painful condition in which the nail grows so that it cuts into one or both sides of the paronychium or nail bed. This condition has been found only in shoe-wearing cultures and does not occur in habitually barefoot people since it requires downward pressure on the nail by a shoe.
The common opinion is that the nail enters inside the paronychium but an ingrown toenail may be overgrown toe skin. The condition starts from a microbial inflammation of the paronychium, secondary to a granuloma, and the result is a nail buried inside the granuloma. While ingrown nails can occur in both the nails of the hand and feet, they occur most commonly with the toenails. A true ingrowing toenail, or onychocryptosis, is caused by the actual penetration of the flesh by a sliver of nail. This should not be confused with other painful nail conditions such as involuted nails, or the presence of small corns, callus or debris down the nail sulci (grooves either side of the nail plate) or under the nail plate itself. Also it should not be confused with a similar nail disorder, onychocyrtosis (from Greek ὄνυξ onyx "nail" + κυρτός kyrtos "convex") or convex nail.
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