ingrown toenail avulsion

ingrown toenail avulsion; Zadek's procedure

Indications: - ingrown toenail Procedure: 1) equipment a) straight mosquito hemostat b) straight scissors c) septal elevator d) 3/8 inch Penrose drain or sterilized rubberband e) dermal curette f) needle holder g) fresh phenol solution h) electrofulgurator unit with insulated probe i) #15 bladed scalpel 2) anesthesia a) 1-2% lidocaine, 2 mL for field block b) 1% Marcaine, 1-1.5 mL for wing block 1] with or without lidocaine 2] may be used for post-operative pain management 3) cautions a) diabetes mellitus b) immunocompromised patients c) patients with circulatory disease 4) technique a) apply field block of the toe & wait 10 minutes for anesthesia: infected nails are tender b) prepare skin with povidone-iodine or Hibiclens c) apply a few layers of gauze around the base of the toe to protect digital neurovascular bundles, followed by application of a Penrose tourniquet, held with hemostat to ensure bloodless field d) free portion of nail plate from nail bed & matrix with septal elevator or straight mosquito hemostat e) grasp spicule with hemostat & avulse by rotation toward main nail plate f) curette proximal nail matrix & any granulation tissue present g) phenol: 1] protect surrounding skin with antibiotic ointment 2] apply fresh phenol (88% carbolic acid) to base of nail to ablate any remaining matrix & assist in hemostasis 3] use 3-soaked applicator sticks for 1 minute each (with pressure) h) electrocautery is an alternative to phenol i) remove hypertrophic nail fold by wedge excision if indicated & suture skin edge to remaining nail plate j) remove tourniquet, apply antibiotic ointment to wound followed by non-adherent dressing 5) follow-up a) elevate foot & apply ice for initial bleeding & pain b) opiate analgesics for 2-3 days c) 1st redressing in 4-7 days or as needed for bleeding d) serous drainage from phenol treatment is expected e) healing is generally complete in 4 weeks f) spicule regrowth is common, regardless of the method requiring a 2nd albiet lesser procedure

General

nail plate avulsion

References

Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 985-86

Contents

Search