Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
If an infection is present, then surgical removal of either part of the nail or the whole nail and drainage of the abscess will be needed. This is performed in the doctor's office or in the
emergency department. The extent of the procedure will depend on the severity of the infection, any other medical problems, and if this is a recurring problem.
How ingrown toenails are surgically removed
A tetanus immunization will be given if it has been longer than five years since the last one. With an ingrown toenail, there is a chance the open wound could develop tetanus.
Sometimes a pre-operative X-ray will be taken to make sure that the infection hasn't spread to the bone (osteomyelitis)
The doctor will inject anesthetic medicine at the point where the toe joins with the foot. This will make the entire toe numb.
The doctor will then drain the infection from the end of the toe or remove the extra tissue that has grown around the end of the nail.
At this point, the doctor will remove a portion of the nail so that the skin
or infection can heal without the nail pushing on it.
The doctor may decide to destroy some of the cells that make the nail grow back by applying a chemical (phenol or sodium hydroxide) to the skin under the nail. Adding phenol at the end of the procedure decreases recurrence rates but can be associated with increased infections. Some alternative methods of ablating the cells include lasers, electrocautery, or extreme cold. This is performed so that the edge of the nail that caused the problem will not return, which is more likely with severe or recurring infections.
For very severe or recurrent cases that have already failed traditional surgery, a complete excision of the nail bed can be done.
A lateral matricectomy is a procedure that surgically removes a portion of the nail bed and is usually performed by a specialist. It is considered the usual treatment for chronic or recurrent ingrown nails.
There are several newer types of surgery that don't alter the nail bed at all, instead they removes a portion of the soft tissue beside and/or underneath the nail in order to make more room for the nail to grow out. These types of surgery have shown promise but are not yet the standard of care, as they are still being studied. A flexible tube can also be slid along the side of the nail after removal of the extra tissue to help it heal properly.
Antibiotics are usually not prescribed for this problem because draining the abscess will take care of the infection.
The toe will then be covered with ointment and gauze.