Ingrown toenail surgery is typically performed to treat a painful and recurring ingrown toenail that does not respond to conservative treatments. Two common surgical options for ingrown toenail treatment are partial nail avulsion with chemical matrixectomy and sharp nail resection known as Winograd procedure. Here’s an explanation of these procedures and the key differences between them:

1. Partial Nail Avulsion (PNA) with Chemical Matrixectomy: Partial nail avulsion is a common surgical procedure used to treat ingrown toenails. In this procedure, a portion of the toenail is removed, specifically the portion digging into or irritating the surrounding skin. Here’s how the procedure is typically performed:

  • Anesthesia: Before the surgery, a local anesthetic is administered to numb the affected toe, ensuring that you do not feel pain during the procedure.
  • Nail Removal: The surgeon will then carefully remove the ingrown portion of the toenail using specialised instruments. This often involves cutting a small wedge from the nail that is causing the problem.
  • Matrix Removal: A strong acidic chemical known as Phenol is then applied to the nail matrix to prevent the ingrown nail from growing back.
  • Dressing and Aftercare: After the procedure, the surgeon may place a dressing or antibiotic ointment on the wound and provide instructions for post-operative care. You need to keep the area clean and dry while it heals.
  • Healing Time: As the wound is left open to heal and chemical causing burn to the tissue, it may take up to  3-4 weeks before it is fully healed. During the healing period, it is usually painless.

 

2. Sharp Nail Resection: Sharp nail resection, also known as the Winograd procedure, involves partial plate excision, abnormal inflammatory granulation tissue(Hypergranulation tissue) and subjacent destruction of the growth centre. This procedure is usually reserved for more severe cases of ingrown toenails or when other treatments have failed. Here’s an overview:

  • Anesthesia: Like partial nail avulsion, a local anesthetic is used to numb the toe.
  • Nail Removal: The ingrown section, hypergranulation tissue and nail matrix are all removed in one piece.
  • Matrix Removal: The surgeon removes a portion of the nail matrix to prevent regrowth and the wound is then closed using 2-3 sutures. Sutures are typically removed in 7 days and patients can return to normal activities.
  • Aftercare: Post-operative care instructions are provided, which usually involve keeping the wound clean, applying dressing or ointment, and avoiding infection.

 

Key Differences:

  1. Extent of Nail Removal: The primary difference between partial nail avulsion and sharp resection is the extent of nail removal. PNA removes a little more nail plate than the sharp nail resection as it does not remove hypergranulation tissue.
  2. Recurrence Risk: Both procedures have shown to be highly effective ranging from 95-98% success rate in the literature.
  3. Severity of Ingrown Toenail: The choice between these procedures depends on the severity of the ingrown toenail and the surgeon’s assessment of the situation. Less severe cases are often treated with PNA, while more severe and recurrent cases may require sharp resection.

Both procedures are generally safe and effective for treating ingrown toenails, but the choice of which one to undergo will depend on individual circumstances and the recommendations of a healthcare professional.

At Brisbane Gold Coast Foot Surgery, we have our state-of-the-art procedure room, where minor surgical procedures are carried out in the hospital standard sterilisation.

We also offer various anesthetic options such as local anesthesia, oral sedation, and Penthrox (green whistle, Methoxyflurane) in the clinic setting. If you are extremely anxious about needles, we can also perform under GA in the hospital setting.

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