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Surgical treatment of ingrown toenails in children: what is best practice?
S Mitchell1, C R Jackson, D Wilson-Storey
1Department of Paediatric Surgery, Royal Hospital for Sick Children, Edinburgh, UK. sarahannemitchell@hotmail.co.uk
Insights
Wedge resection with phenol is recommended for ingrown toenails (IGTN). Excision of the nailbed with phenol had the lowest recurrence rate, making it optimal for recurrent cases.
Area of Science:
- Podiatric surgery
- Dermatological surgery
Background:
- Ingrown toenail surgery has a high re-operation rate.
- Optimal management strategies for ingrown toenails require assessment.
Purpose of the Study:
- To review departmental figures on ingrown toenail surgery.
- To determine the most common procedures and their re-operation rates.
Main Methods:
- A 10-year retrospective review of ingrown toenail surgeries.
- Analysis of 880 procedures performed on 414 patients.
Main Results:
- Wedge excision with phenol was the most common initial and repeat procedure.
- Recurrence was highest after simple or wedge avulsion without phenol.
- Nailbed excision with phenol had the lowest recurrence rate (18.4%).
Conclusions:
- Recommend wedge resection with phenol as first-line treatment.
- Reserve simple avulsion for infected toes and total nail bed excisions for severe morbidity.
- Tailor surgical choice to individual patient outcomes and inform families.
Introduction:
Surgery for ingrowing toenails carries a significant re-operation rate. We reviewed our departmental figures to assess the optimal management of these patients.
Patients And Methods:
We performed a 10-year retrospective review of all patients undergoing surgery for ingrown toenails (IGTN) in order to determine the operations most commonly used and the re-operation rate of each of these procedures.
Results:
A total of 880 procedures were performed on 414 patients. The median age at operation was 8.5 years. About half (48%) of children underwent two or more procedures with wedge excision and phenol application being the most common initial and repeat procedure. Recurrent surgery was most likely following plain avulsion or wedge avulsion without phenol application. Excision of the nailbed with phenol application had the lowest recurrence rate at 18.4%.
Conclusions:
We recommend wedge resection with phenol application as first-line treatment with simple avulsion reserved for severely infected toes. Total nail bed excisions should be reserved for patients with significant on-going morbidity associated with IGTN. Families must be made aware of the likely outcome of IGTN surgery and the choice of operation must be tailored to the individual.
