Ingrown toenail surgery. Ingrown toenail: all methods of surgical treatment. Big toe nail removal cost
All materials on the site are prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and are not applicable without consulting the attending physician.
Ingrown toenail removal is a surgical operation in which all or part of the nail plate is removed. The treatment is carried out under local anesthesia. Efficacy is limited by the high recurrence rate.
The problem of an ingrown toenail is familiar to many of us. It can take months to fight the disease without surgery, and the result will be the absence of a clear effect and the progression of the pathology. In this case, the only radical method of treatment is the surgical removal of the ingrown nail.
ingrown nail plate possible in both adults and children. Having arisen once, pathology not only delivers a lot of unpleasant sensations, but also forces you to change your lifestyle. The patient has to limit himself in physical activity walking even short distances causes great discomfort. Wearing your usual shoes may become impossible.
The causes of an ingrown toenail are varied. These are injuries of the nail bed with improper foot hygiene and too deep cutting of the nails, and wearing ill-fitting, tight shoes. Often, the disease occurs in women as a retribution for the passion for heels, especially if the toe of the shoe is narrow and elongated shape. Deformities of the toes, flat feet also contribute to the pathology of the nails.
The children themselves common cause ingrowth of the nail into the lateral surface of the fingers is an incorrect circumcision, when the parent cuts off with a careless movement more fabric than necessary.
Physical discomfort in the form of pain, chronic inflammation, often purulent, growth in response to constant irritation of the periungual fold of granulation tissue contribute to the deformation of the nail, make the cutting process impossible, and walking painful. Equally important is the aesthetic side of the disease - the finger looks, frankly, ugly.
If for a basically healthy person an ingrown nail is a local problem, then for patients with diabetes mellitus, atherosclerosis of the vessels of the legs, and inflammatory vascular diseases, it poses a much more serious danger. Disturbed blood flow prevents regeneration, causes tissue necrosis in the area of inflammation, and the result of treatment may be the amputation of the entire finger.
People of working age who lead an active lifestyle, athletes experience great inconvenience due to the need to limit themselves in their usual activities, walking, sports events. Travel becomes a problem, driving brings pain, and good and beautiful shoes goes to indefinitely for a long time into the cupboard.
In an effort to avoid surgery, patients resort to a variety of conservative methods of treatment, ranging from folk remedies and ending with the application of various ointments. In an attempt to remove the excess nail on their own, they further injure the already inflamed and painful skin, aggravating the course of the disease.
Conservative and orthopedic treatments for onychocryptosis are common, but they do not bring the desired effect. Their main disadvantages are the need for frequent dressing changes, which is very painful, significant inconvenience when wearing shoes, and often you have to use orthopedic shoes for up to six months, limiting an active lifestyle, playing sports, etc.
Even scrupulously and meticulously fulfilling all the doctor's prescriptions, it is difficult to achieve a cure without surgery. In addition, not all patients with an ingrown nail have the opportunity to change dressings in a timely manner, treat the affected area and attend procedures in the clinic due to being busy at work.
These factors make the alternative to ingrown toenail surgery more attractive. It should be noted that the much higher efficiency of surgical treatment, different ways offered by both public hospitals and private clinics.
Methods of surgical treatment of an ingrown nail
The indication for surgical removal of an ingrown nail is considered to be the very presence of an ingrown nail,especially if it is accompanied by purulent inflammation, severe pain and deformity. With severe inflammation, the surgeon may delay the operation by prescribing anti-inflammatory conservative treatment to reduce the possibility of recurrence and complications.
Surgical removal of an ingrown toenail is the most radical method of treatment, but it is not without drawbacks, the main of which is considered to be a high recurrence rate. Individual features of the structure of the nail bed, errors in the technique of the operation, non-compliance with the recommendations of the doctor during the rehabilitation period lead to a recurrence of the disease.
The essence of surgical treatment, regardless of the chosen technique, is to remove all or part of the nail with the obligatory destruction of the growth zone. To reduce the percentage of recurrence, various modifications of the traditional excision of the nail plate are offered.
Surgery to remove an ingrown toenail local anesthesia solutions of novocaine or lidocaine, which are injected along the lateral surfaces of the finger. During the manipulation, the patient may feel that something is happening to the finger, experiencing anxiety at the same time, but you should not be afraid - anesthesia reliably protects against pain. A tourniquet is applied to the base of the finger to prevent bleeding.
To date, more than a dozen methods for removing an ingrown nail have been proposed. Each of them has both advantages and disadvantages, differs in the area of nail resection, the type of treatment of its bed, and the course of the postoperative period.
The method of simple removal of the nail plate - Dupuytren's operation- is used quite widely, but one cannot help but point out its low efficiency: the recurrence rate is 90% or more even when only half of the nail is excised.
The essence of the operation is as follows:
- Ensuring anesthesia of the soft tissues of the finger;
- Dissection of the nail plate in half with twisting of each half with a clamp;
- Careful removal of granulation tissue in the ingrown area.
The nail bed after the extraction of the nail remains untouched, but it is possible to excise the periungual ridges with modeling the shape of the bed for cosmetic purposes.
after operation
The postoperative period with this type of surgery is long - several weeks and even months. During this period, the patient experiences severe pain, is forced to give up walking and wearing ordinary shoes, often the performance of labor duties becomes impossible, and a sick leave is issued.
In addition to the high risk of recurrence, the Dupuytren operation has another significant drawback - cosmetic defect. After regrowth, the newly formed nail will be narrower and denser than the removed one, deformation is characteristic, often the nail resembles animal claws, bringing the patient suffering about the aesthetics of the treatment result.
Currently, surgeons are trying to limit the Dupuytren operation to cases where, in addition to ingrowth, there is a fungal infection of the nail plate, subungual panaritium(purulent inflammation), osteomyelitis of the phalanx of the finger or phlegmon.
A type of surgical treatment for an ingrown nail, when the nail plate remains in its original place, is the Barlett operation, proposed back in the first half of the last century. With this type of intervention on the side of the ingrowth, 5-7 mm away from the edge of the nail fold down, a longitudinal incision is made through which the underlying tissues are removed to the bone. The skin incision is sutured with a silk suture, the tension of the threads of which moves the roller away from the edge of the nail where the ingrowth has occurred. Some surgeons suggested not suturing the tissue, but leaving the defect gaping.
The recurrence rate for Barlett surgery is about 30%. It is more expedient to carry it out when the inflammatory process subsides somewhat under the influence of conservative therapy.
In 2004, a method was developed for the surgical removal of an ingrown nail, when its bed expands, tissue compression in the area of the roller is eliminated, and the growth zone remains intact. The method is quite effective, relapses occur in about 11%.
Meleshevich's operation, proposed back in 1985, was quite progressive, which involves:
- Resection of the trapezoid area of the periungual roller;
- Expansion of the area of the nail bed;
- Plastic surgery of surrounding tissues.
In a clinic settingapply different types interventions and their modifications. Maybe:
- Complete removal of the nail with the growth zone and ridges (the most traumatic, poor cosmetic result, frequent relapses);
- Removal of the edge of the nail and the growth zone with / without a section of the roller;
- Resection of a nail fragment with a roller and preserving the growth zone.
One of the commonly used types of surgical treatment of an ingrown nail is the Emmert-Schmieden operation, which in the classical version consists of several stages:
- Longitudinal dissection of the nail, retreating up to 5 mm to its center from the place of ingrowth;
- Removal of the affected part of the nail by twisting;
- Deepening the incision to the periosteum with the removal of the wedge-shaped tissue from the region of the roller;
- Approximation of the edges of the wound and suturing.
The Emmert-Schmiden operation, like other types of interventions, does not guarantee a lasting effect, and the probability of recurrence with it reaches 46%.
The most radical method of treating pathology can be considered the total removal of the nail with underlying tissues up to the periosteum. Such an intervention requires subsequent plastic surgery of the phalanx with your own skin or artificial. Total removal of the nail is performed only in advanced cases, if it is impossible to use other methods and the disease recurs.
Consequences of total resection become a decrease in the stability of the finger to mechanical stress, pain when wearing shoes, injury, deformation of the distal phalanx. Plastic surgeries designed to improve the appearance in a third of cases proceed with necrosis of the transplanted skin, which gives an even worse result in the end.
When all methods of dealing with an ingrown nail fail, and the patient continues to suffer from constant recurrence, it is possible removal of the entire phalanx of the finger. The operation is crippling, it is characterized by extremely low aesthetics, although once and for all it eliminates the pathology. This intervention, rather, refers to the operation of "desperation".
As you can see, a lot of surgical techniques for the treatment of an ingrown nail have been proposed, even more various modifications have been developed, but none of the methods gives a 100% result. This explains the ongoing efforts to find best option removal of an ingrown nail.
Removal of an ingrown nail with a laser and other low-traumatic methods
In addition to the described, "purely surgical" methods of treating an ingrown nail, others have been developed that combine the excision of the edge of the nail plate with exposure to some type of energy - laser, electric current, radio waves.
laser treatment
laser treatment has gained wide popularity in all areas of medicine, it is also used for ingrown nails. The essence of the operation of laser removal of pathology is the preliminary excision of the altered area of the nail plate with scissors, after which the growth zone is exposed to a laser beam, which removes the surface layer and permanently prevents the growth of the nail plate in this place.
The attractiveness of laser treatment is due to the excellent aesthetic result of the operation. After the usual removal of the affected nail, the regeneration process drags on for many months, and the newly formed nail is very far from ideal and may remain so forever. The laser, on the other hand, allows minimizing tissue trauma and ensuring the growth of a healthy and beautiful nail plate.
Advantages of the laser technique:
- A guarantee of a complete cure, when a relapse is possible in no more than one out of a hundred patients;
- Preservation of the germ layer and removal of only altered tissues, ensuring the aesthetics of the treatment;
- Fast recovery and minimal pain;
- Extremely low frequency of complications - bleeding, infection - due to the disinfecting effect of the laser and the ability to "solder" the blood vessels; it is quite possible that carriers of the fungus will get rid of this problem after laser treatment;
- Safety that makes laser treatment attractive to patients childhood and those who are sensitive to even mild pain.
The technique of laser treatment of an ingrown nail consists in treating the affected finger with a light beam to remove excess granulations, then a section of the altered nail platinum is cut off, and the site of pathological growth is treated with a laser, as if evaporating excess germ cells. Thus, only that part of the nail growth zone that has become redundant is subjected to irreversible destruction, the remaining tissues are not affected.
The laser treatment operation lasts about 20 minutes, is performed under local anesthesia, and ends with the application of a clean bandage. The patient experiences little or no pain and can go home.
Regeneration of the laser treatment area takes no more than a week, during which antibacterial drugs can be prescribed for an increased risk of infection (for example, in diabetics or people with weakened immune systems). For the next few weeks, the patient wears comfortable shoes, avoids going to the bathhouse and sauna, does not burden himself physically and long walks on foot.
Even considering the high degree of safety of laser correction, there are still some contraindications to it. For example, severe diabetes mellitus, serious problems with blood clotting, acute infectious diseases, cancerous tumors, hypersensitivity to light radiation.
Complications of laser treatment are extremely rare and, as a rule, are associated with a violation of surgical technique. This may be an excess of the duration of the intervention, provoking trophic disorders up to necrotization, damage to surrounding tissues during careless laser manipulations.
The appearance of the finger after treatment is usually satisfactory to patients, but there may be some dissatisfaction if expectations were too high. The nail after laser treatment will be smooth and even, but its width will inevitably decrease, which does not affect the appearance too much, but the patient may not like it.
Radio wave treatment and electric shock pursue the same goals as laser therapy, that is, the removal of the matrix that serves as the basis for re-ingrowth. The advantages of these treatments are considered to be a low recurrence rate and a good cosmetic result. They can complement both partial resection and complete removal of the nail.
Radio wave treatment has a number of advantages: healing is painless, all stages of the operation can be performed using a special scalpel, radio waves have a beneficial effect on tissues (increase regeneration, have an antimicrobial effect). Healing with radio wave treatment of an ingrown nail is faster and more effective than when using a laser, ultrasound or electric current.
To reduce the frequency of relapses, the treatment of the growth zone at the site of nail ingrowth with various chemical compounds - phenol, alcohols, silicone plates, gel, paraffin, compositions based on bee honey, with povidone-iodine, etc. .
Video: removal of an ingrown nail using a radio wave method
After operation
After the ingrown toenail removal procedure, the patient can either go home immediately if the operation was performed on an outpatient basis, or stay in the hospital for several days. The duration of hospitalization is determined individually. Skin sutures are removed on the 7-10th day.
Recovery period with certain types of interventions, it can take several weeks or even months. All this time, you need to strictly follow the doctor's recommendations, monitor foot hygiene, avoid overloading them, and carefully select shoes that are likely to be orthopedic in the first weeks. If there are concomitant problems in the form of flat feet and deformities of the feet, then special insoles and arch supports are shown to facilitate the healing period.
Particular attention should be paid to the condition of the fingers of persons with diabetes mellitus, trophic changes in the legs. It is important to correct the course of comorbidity as much as possible in order to prevent not only recurrence, but also postoperative tissue necrosis. It is possible to additionally prescribe conservative therapy in the form of vitamins, vascular agents, drugs to improve trophism and regeneration.
An important point in planning treatment is the choice of a clinic and a doctor who must have sufficient experience in carrying out such manipulations, it is good if the specialist has already completed special courses.
Ingrown toenail removal operations are performed free of charge at a polyclinic or hospital (in the direction of a polyclinic surgeon). They are not high-tech, do not require special expensive equipment for the operating room, and the state can fully cover all expenses.
On the other hand, many patients, wanting to get really high-quality care, turn to private clinics for paid treatment. If there is a desire to perform an operation at your own expense, then the cost of treatment should not be the starting point when choosing a clinic. It is much more important to find out the qualifications of the operating surgeon and his experience in the treatment of a particular pathology. It is quite possible that treatment by a high-class professional will cost less in one clinic than the services of a novice surgeon in another, but the reverse situation (which is quite logical) is also possible.
The cost of surgical treatment of an ingrown nail is approximately 2-3 thousand rubles. Some clinics offer to do this for 5-7 thousand. Laser treatment lies in approximately the same price range, radio wave therapy is somewhat more expensive - ranging from 3-4 thousand rubles and more. The choice depends on the wishes and solvency of each patient.
An ingrown toenail is an extremely common problem in which the nail plate grows into the skin, usually on one side, sometimes on both. Most often, this condition develops on the leg, on thumb, but other options are possible. In most cases, you can not do without the removal of an ingrown nail, it is worth considering the main methods for carrying out this operation.
There are several reasons why the nail begins to grow into the skin tissue nearby. In most cases, this is due to wearing uncomfortable, too tight shoes, due to improper foot care. People with various foot deformities are more likely to develop ingrown. Also, the nail can grow in due to injury, for example, due to a blow, a broken finger.
At first, this state may not deliver special pain, however, over time, it can become quite severe, often a full-fledged inflammatory process develops. If you run it, it can lead to gangrene of the finger. The risk of developing this process is increased in people suffering from diabetes, circulatory disorders.
Therefore, an ingrown toenail must be removed, preferably by a doctor. Self-treatment this disease can lead to serious consequences, so it is better to trust the experts. It is worth considering the main methods for removing an ingrown nail, their pros and cons.
Important! You should not try to cut a deeply ingrown nail plate yourself, this can lead to the spread of infection in the tissues of the finger.
There are several methods for performing this operation, they differ slightly in indications, pain and cost. You should choose based on individual characteristics and capabilities, all methods are quite effective.
Surgery to remove the nail surgically is the easiest and cheapest method for this procedure. The removal may be complete or incomplete. With incomplete removal, only a piece of the nail plate is cut out, which ended up in the tissues of the finger. Incomplete removal is carried out if there are no signs of a pronounced inflammatory process.
Complete removal is performed if the inflammation covers soft tissues around the nail plate. With complete removal, the entire nail plate is completely cut out, in this case, the recovery process after the operation will be much longer.
The main advantage of surgical treatment is the absence of the likelihood of recurrence. You can perform this operation in any clinic, for this it is not necessary to contact paid clinics. Usually the procedure is completely free, it takes only 20-30 minutes, after which you can immediately go home.
The disadvantages of this procedure are rather high pain, a long healing period. With complete removal, it can take up to a month, while the first time after the operation, the finger will need mandatory care.
The surgical method is the simplest of the existing ones, it can be carried out almost everywhere, it is not necessary to look for a specialized clinic where an ingrown nail is removed for a teenager or an adult.
An ingrown nail can be removed for a child using a similar procedure, however, if possible, experts advise choosing a more gentle method. Surgical treatment is best left in case the inflammatory process becomes too severe and treatment by other methods is impractical.
Important! After a complete surgery, a bandage is usually required.
Ingrown toenail laser removal
With this procedure, pain is usually minimal, it lasts 30-40 minutes, sometimes repeated sessions are required. The essence of laser treatment is to remove the soft tissues around the ingrown nail plate, as a result of which it is released.
This method is suitable in the absence of a severe inflammatory process, when deep intervention in soft tissues is not required. At the same time, an obvious plus of this method: during laser treatment, bacteria and fungi are completely removed from the surface of the nail plate and nail bed.
The disadvantages include the high price of this procedure, usually it can be carried out exclusively in private clinics. The healing process also usually takes enough long time However, this is more dependent on the individual characteristics of the course of the disease.
This technique is the most effective and painless on this moment. During the procedure, soft tissues are exposed to directed radio waves, usually one session is enough, sometimes several are required. There is practically no pain during the session, after the procedure it does not take much time for the recovery process.
The disadvantages of this technique are practically absent. These include the high cost of the method and rather low availability, not all clinics provide this service. Also, a radio wave operation requires advanced qualifications from a doctor, since if the power and direction of the waves are incorrectly selected, the treatment may not give the desired effect.
How to remove an ingrown toenail at home?
Removing an ingrown toenail at home is usually not recommended, since it is likely to only aggravate the condition. However, if the nail plate has just begun to grow in, pain and inflammation are completely absent, you can try to cope with this condition on your own.
First of all, you need to prepare a hot bath based on antiseptic agents. As an antiseptic, you can use sea salt, soda, chlorhexidine, furatsilin, potassium permanganate, infusion of St. John's wort, celandine, eucalyptus or chamomile, but it is better to give preference pharmaceutical products. The selected product must be added to hot water, the foot or palm with the ingrown nail must be immersed in the mixture. The best way to do this is with a small bowl.
From above, it is advisable to cover the basin with a towel or other dense cloth. The limb should be held for 15 - 20 minutes, then wiped dry. You need to take manicure scissors, before the procedure it is desirable to treat them with chlorhexidine.
After steaming, if the nail is not deeply rooted, it usually comes out of the steamed skin on its own. With nail scissors, it is imperative to cut off the sharp edge ingrown into the skin, it is advisable to process it with a nail file.
After the procedure, you need to apply Levomekol or Panthenol, you should not put on a patch or bandage. To avoid relapse, it is advisable to repeat the baths several times during the week. During healing, be sure to wear loose, comfortable shoes and change socks every day.
A similar method of home treatment is not suitable in all cases, if the inflammatory process has already occurred, the nail should be removed by a doctor. Surgery by a specialist is most desirable in any case, regardless of the severity of the disease.
The operation to remove an ingrown toenail is different. So, surgery is used in case of suppuration of the tissues surrounding the plate, but laser treatment and radio wave therapy are also used at the initial stages of pathology development. The sooner a person decides to eliminate the phenomenon, the less traumatic the intervention will be.
The disease when the nail grows into the surrounding tissue is called onychocryptosis. Often the nail plate of the big toe suffers. In the early stages, the treatment of pathology is carried out using conservative and even folk methods, however, in severe cases of an ingrown toenail, when suppuration and other complications are observed, the plate must be removed. However, how is an ingrown nail removed surgically and what are the operations?
Indications for surgery
The process of ingrown toenail is a serious problem and in certain circumstances is a serious danger to human well-being. The problem is that most people try to cure or excise the problem nail on their own. However, a simple circumcision cannot improve the situation, since the main cause of the disease is the changed direction of plate growth, which occurs for a variety of reasons.
The most common reasons for this phenomenon:
- flat feet;
- heredity;
- fungal diseases;
- wearing uncomfortable shoes.
Attempts to correct the condition without eliminating the causes can lead to serious complications, for example, purulent inflammation of the phalanx of the thumb (gangrene) and its subsequent amputation. The surgical removal of such a plate is carried out according to the strictest indications and only when the disease has become more complicated and the situation cannot be corrected by conservative methods. A person in this case can say that an ichor, blood or pus has appeared at the site of ingrowth, in particular, when there is an increase in soft tissues.
That is why, as soon as the nail begins to grow in or just a slight discomfort appears in the foot, it is necessary to immediately consult a doctor, especially if children have found the symptoms. Untimely measures, most likely, will entail the removal of the plate. Nevertheless, the level of medicine does not stand still. Previously, the basic method of therapy was considered to be the elimination of the entire nail plate, but now surgery has in its arsenal the latest and advanced technologies that eliminate the cause of ingrowth and give the nail a natural direction of growth.
However, with an ingrown nail, intervention is unacceptable in such cases:
- taking certain drugs that affect blood clotting (acetylsalicylic acid and its analogues);
- diseases of the heart vascular system and vasoconstriction lower extremities;
- endocrine diseases (for example, a severe stage of diabetes mellitus).
As a rule, such methods of surgical intervention are now used, such as surgical removal of the nail plate (complete and partial), removal by the wave method, and nail correction is carried out, in which a laser is used.
Pros and cons of different methods
But how to decide on the method of operation so that it is suitable and permanently solves the problem? It should be noted that the main distinguishing feature of these methods is the specific effect on tissues, that is, a scalpel, laser or radio waves are used. The point in determining the ideal method in a particular situation is put by the attending physician, after examination and a comprehensive examination of the patient. However, it is important not to forget that positive and negative aspects are inherent in all methods of correction.
Surgical method
Removal of the plate with the help of surgery (resection) can be complete or partial. The latter option is used when the nail fold is thickened, but the adjacent tissues and the nail itself do not fester. Complete resection of the plate is practiced in the case when tissue suppuration is observed. The unequivocal advantage of this method is the ability to prevent purulent damage to the bones, in particular, during partial resection.
The negative points include the fact that dressing should be performed regularly after removal of the ingrown nail, and anesthesia is required during the intervention. Bandaging is carried out until the tissues are completely healed and a new nail plate grows. Sometimes this process takes months. In addition, a serious minus is the likelihood of damage to the growth zone during a complete resection, as a result of which the nail may not grow at all, or sometimes a relapse is observed. However, it should be noted that these operations are now infrequently performed.
Laser correction
The laser is used quite often, since the method has many good points. In addition, there is no need to completely remove the plate, which means that there is no risk of damage to the growth zone. The laser vaporizes the granulation area of the nail fold, as well as the ingrown plate itself. The definite advantages of the method include:
- the procedure does not require anesthesia, since it is painless;
- parallel sanitation from infectious agents and fungus;
- can be applied even to a child;
- high efficiency rate.
In addition, the laser is used not only in the correction of an ingrown nail, but also in the elimination of valgus deformity of the foot. Many people, in particular women, suffer from valgus pathology. Due to the development of hallux valgus, the foot itself and the toes are distorted. A characteristic feature of hallux valgus is the deviation of the thumb inward and the formation of a "bone". In many advanced medical centers, in particular, in the Albrecht Clinic, hallux valgus is corrected, and the problem of an ingrown plate is eliminated with a laser. The method has practically no disadvantages, although some patients point out the possibility of long-term tissue healing after the correction of the ingrown nail plate.
Radio wave method
As already mentioned, during this procedure, the elimination of the problem of the ingrown plate is carried out using high-frequency radio waves. The positive aspects of the method include:
- painlessness;
- low trauma;
- high performance;
- fast healing process.
The only possible negative consequence of such an intervention is the incorrect selection of the power of exposure by the doctor. In this case, a recurrence of the phenomenon is quite likely. However, such a moment is rather a minus for a specialist, and not for the method as a whole.
How is nail removal performed?
Of course, all types of operations are performed on an outpatient basis. When anesthesia is used in the procedure, it is usually local. Often use a solution of lidocaine or novocaine. In general, the operation takes 20-30 minutes, during which the doctor manages to provide anesthesia, remove the ingrown nail and apply a bandage. The patient also recovers from anesthesia quite quickly - after a few hours.
Recovery after the intervention is often quick, but occasionally you need to visit a doctor for an examination and bandage replacement. When the area of the removed plate was insignificant, then this place overgrows in a week. However, I would like to remind you once again: with such an ailment, it is very important to visit a doctor in the early stages of the development of the disease, since this will serve as a guarantee of short terms of therapy and the absence of complications.
The ingrowth of the nail plate into the surrounding tissues is called onychocryptosis. In the early stages, treatment can be carried out using conservative and even alternative methods of treatment, but in advanced cases, when complications develop, the nail must be removed. How is an ingrown toenail removed surgically, and what are the main methods used? We will talk about the advantages and disadvantages of each method.
The process of ingrown nails into soft tissues is a serious problem and in some cases can be a health hazard. The fact is that many patients try to treat or cut off an ingrown nail on their own. But the problem cannot be solved by simple circumcision, since the main cause of the disease is a change in the direction of growth of the nail plate, which occurs due to a variety of reasons.
Among the main reasons are wearing uncomfortable shoes, flat feet, fungal diseases, and heredity. Attempts to treat the disease without eliminating the causes can lead to formidable complications - purulent inflammation of the phalanx of the thumb (gangrene) and its subsequent amputation.
Surgical removal of an ingrown nail has strict indications and is performed only in cases where the disease is advanced and the disease cannot be cured by conservative methods. At the same time, the patient may complain about the discharge of purulent or sanious contents from the place of ingrowth, especially if there is an overgrowth of soft tissues.
That is why it is necessary to consult a doctor when the first signs of an ingrown nail appear. If this is not done, the removal of the nail plate cannot be avoided. But surgery does not stand still - if earlier the traditional removal of the entire nail (surgical method) was considered the main method of treatment, then modern medicine has advanced and latest techniques for performing the operation, when the cause is eliminated and the nail is corrected at the same time.
With an ingrown toenail, surgery is not performed in the following cases:
- taking certain groups of medicines that affect the blood coagulation process (for example, aspirin and its analogues);
- diseases of the endocrine system (for example, severe stage of diabetes mellitus);
- diseases of the vascular system and narrowing of the large vessels of the legs.
The following are the corrective action methods:
- surgical removal (complete or partial) of the nail with a scalpel;
- laser nail correction;
- nail correction using high frequency radio waves.
Advantages and disadvantages of different methods
How to choose a method of operation so that it is optimal, and with its help it is possible to radically solve the problem? The main difference between all methods lies in the way the tissue is processed - whether it is a scalpel, a laser beam or radio waves. The final verdict on which method to choose is decided only by the doctor during the examination of the patient. But, nevertheless, there are pros and cons for each method of operation.
Surgical method
Surgical removal of an ingrown nail can be complete or partial (resection). Partial resection is performed if the nail fold is thickened (granulation), and the nail itself did not cause signs of suppuration. Complete removal of the nail is performed in cases of suppuration of soft tissues.
Laser correction
It is often used, as the method has many advantages. In this case, there is no need to damage the growth zone or completely remove the entire nail. With the help of a laser, both the granulation part of the nail fold and the ingrown nail itself are evaporated.
Radio wave method
An operation to remove an ingrown nail with this method is performed using high-frequency radio waves.
How is the removal of the nail
All operations without exception are performed on an outpatient basis. The method of anesthesia is local, with a solution of lidocaine or novocaine. The operation time is only 20-30 minutes, during which the doctor manages to administer anesthesia, remove the ingrown plate and apply an aseptic bandage.
Ingrown nail- a disease in which the edge of the nail plate grows into the periungual roller.
Ingrown Toenail Facts:
- A very common disease that surgeons encounter quite often.
- Most often found on the big toe.
- As a rule, the outer edge of the nail grows.
- An ingrown toenail is often complicated by an infection.
- The disease can develop both in adults (about 60% of patients) and in children (about 40%).
- Men and women suffer from the disease about equally often.
Features of the anatomy of the finger and nail
Nails are derivatives of the skin, just like hair. They cover the terminal phalanges of the fingers and toes and perform a number of functions:- protection of sensitive pads of terminal phalanges;
- participation in the capture of small objects;
- nails help the fingers to rest and better touch different objects;
- with the help of nails, a person can scratch the skin and relieve the feeling of itching;
- you can pick it up with your fingernail various items;
- aesthetic functions: thanks to nails, fingers have a familiar appearance, beautiful well-groomed nails are one of the important elements of a person's appearance.
Parts that make up the nail:- Nail plate. Visible part of the nail. It is a plate of keratinized cells. It has no nerve endings and capillaries. Normally it is pink. With cooling, as well as with violations of the cardiovascular system, the nail plate may turn pale or acquire a bluish tint.
- nail bed. This is the surface of the terminal phalanx of the finger, on which the nail plate lies. They are connected to each other throughout, except for the free edge of the nail plate.
- nail root. It is a part of the nail plate, which is covered by the skin. This is the "living" part of the nail - here are the cells, due to the division of which the nail grows.
- Crescent, or "moon". The part of the root of the nail that is visible from under the skin. Has a whitish color. It is best seen on the thumbs and almost invisible on the little fingers.
- Cuticle or skin. A thin layer of skin that covers part of the root of the nail. Normally, it is soft and has a small size. But it can harden and grow on the nail, in which case it spoils the appearance, burrs can form on it.
- Nail rollers. They are leather pads that limit the nail at the back and sides. It grows into them side part nail.
How does a nail grow?
The growth of the nail occurs due to the multiplication of cells that are in its root (matrix). Gradually, moving forward, they become keratinized, become dense, pressed. normal growth of the nail is highly dependent on the condition of its root and nail bed.On the hands, the nails grow faster than on the legs, on the right - faster than on the left. Usually, nail growth accelerates in summer and slows down in winter. In pregnant women, nails grow faster.
It usually takes 3 to 5 months for the nail to fully grow back.
The main causes of an ingrown toenail
What does an ingrown toenail look like?
At the beginning of the disease, the periungual roller looks swollen, it has redness. Sometimes, with severe deformation, it is clearly visible how the nail bends. 
Over time, as a result of constant trauma, an ulcer appears on the periungual roller. 
Infection quickly penetrates into damaged skin. The periungual roller swells even more, acquires a bluish or purple hue. Pus exudes from it: 
In response to infection, the tissues of the periungual fold begin to grow excessively - granulations form. These growths are reminiscent of appearance raw meat, which is why they are often referred to as "wild meat". 
An ingrown toenail can also be bilateral. Ingrown toenail symptoms
The main symptom of an ingrown toenail is pain. It worries constantly and increases significantly while walking, especially if worn tight shoes. Pain is due to the fact that in the skin of the fingers is a large number of nerve endings.
Why is an ingrown toenail dangerous?
The constant pain that accompanies an ingrown toenail is a rather unpleasant symptom in itself. It does not allow normal sleep, work, reduces the quality of life. But more serious complications can develop:- abscess(abscess) of the finger;
- osteomyelitis- purulent inflammation of the bone (the final phalanx, with a possible transition to the joint and above);
- gangrene- necrosis of the tissues of the finger.
Diagnosis of an ingrown nail
Which doctor should I contact?
An ingrown toenail is treated by a surgeon (in children - a pediatric surgeon), a podiatrist (a specialist in foot diseases). Having found symptoms in yourself, you need to contact the clinic where such a specialist is receiving as soon as possible. Do I need to take tests?
The doctor may prescribe a general blood testto assess the severity of the inflammatory process in the body. Diabetics are prescribed a blood sugar test.When is X-ray required?
- If osteomyelitis is suspected.
- If the doctor doubts the diagnosis. For example, there is a disease whose symptoms strongly resemble those of an ingrown nail - osteophyte (a bone outgrowth on the phalanx of the finger).
Ingrown toenail treatment
Ingrown toenail treatment without surgery
Foot bathsFoot baths as a conservative method of treating an ingrown nail can only be used in the initial stages, when there is no suppuration and proliferation of granulations. You can make baths with the following solutions:
- saline solution. Take a small amount of salt and dilute in warm water in a bowl. Do foot baths 2 times a day - in the morning and in the evening. This helps to soften the nail plate and correct its deformation.
- soda solution. Dilute a small amount baking soda in warm water in a bowl. Do foot baths 1 time per day, in addition to salt baths. This helps relieve inflammation and prevent infection.
- A solution of potassium permanganate (potassium permanganate). Take a little potassium permanganate and dilute in a bowl in warm water so that you get a weak solution Pink colour. Do foot baths 1 time per day, in addition to salt baths. A solution of potassium permanganate, as well as a solution of soda, helps relieve inflammation and prevent infection from entering the nail fold.
Ointments for ingrown nails
| Name of the ointment | Action | Mode of application* |
| Nogtinorm | Balm, which is applied to the nails and periungual ridges. Compound:
| Before applying the Nogtinorm balm, it is necessary to steam the feet so that the corners of the ingrown nail come out from under the nail ridges. After that, apply the balm on the nail plate and periungual ridges. Repeat the procedure 1-2 times a day.  |
| Uroderm | Ointment, the active substance of which is urea (urea). the effect: as a result of the action of urea, the nail becomes more plastic, easier to cut.  | The ointment begins to be applied 3-4 days before cutting the nails. In the morning and evening, after taking a shower, dry your fingers with a towel. Then take a small amount of ointment, about the size of a grain of rice, and use a special spatula to fill it between the edge of the nail plate and the periungual roller. After that, do not wear socks, slippers and shoes for some time, so as not to wipe off the ointment. |
| Vishnevsky ointment | Ointment Vishnevsky is used for inflammation of the periungual roller. Composition and effects:
|  Apply the ointment to the inflamed periungual roller at night, apply a bandage. Remove the bandage in the morning. If the corner of the ingrown nail has come out from under the roller, you can try to cut it off. |
| Ichthyol ointment | Compound:
|  With an ingrown nail, ichthyol ointment is used similarly to Vishnevsky's ointment. It is necessary to apply a small amount of ointment on the nail roller at night and apply a bandage. In the morning, remove the bandage, try to cut off the corner of the nail. |
| Levomekol | Usually levomekol ointment is used after surgery for an ingrown nail, complicated by suppuration. Compound:
| After surgery for a festering ingrown nail, a bandage with levomekol ointment is applied. It is changed until the wound is completely cleansed and healing begins.  |
Correction of nail growth with the help of various devices
Methods that have been used before:
Today, more modern devices have appeared - various metal springs, brackets, plates. Their edges cling to the edges of the nail plate. Due to the rigidity and special shape, these devices press on the central part of the nail and lift its edges.
There are many such devices. The most common of them:
Surgical treatments for ingrown toenails
Surgery for an ingrown toenail is usually performed under local anesthesia. The operation can be performed on an outpatient basis in a polyclinic.Ingrown toenail surgery options:
Mandatory indications for surgery for an ingrown toenail are conditions such as suppuration and granulation growth.
Ingrown toenail prevention
| What needs to be done? | What should be avoided? |
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