Anesthesia
1. The big toe has been anesthetized and prepared for the correction of an ingrown nail. The toe is bluish in color because a rubber band tourniquet has been applied to the base of the toe.
2. A chisel-like surgical blade called a nail splitter is used to cut the nail from the free edge to the back of the matrix bed. The blade is then used to loosen the part of the nail to be removed from the nail bed and matrix bed. The nail splitter doesn’t cut into the nail bed, only the nail plate.
3. Hemostat forceps are then used to grasp the nail to be removed. With a twisting motion, the nail border is avulsed (separated from the body by cutting) from the nail margin.
4. This shows the nail margin after it was avulsed from the nail groove. Compare its size to what you can actually see of the nail margin in the second photograph. Also, notice the small hook on the bottom of the nail. The sharp part of the hook is what was growing into the soft tissue and causing the pain.
5. Phenol- (89% carbolic acid) soaked cotton applicators are then inserted into the matrix bed area to sterilize the exposed matrix cells. Freshly soaked applications are manipulated in the area for about three minutes to complete this process.
6. A gauze bandage is applied over the toe. It looks large but easily fits into the shoe. Remove this bandage in two days, the patient is instructed to wash the surgical area daily with warm soapy water. Use a triple antibiotic ointment on the site and keep it covered with a small adhesive bandage.
by Dr. Godfrey F. Mix
Nails Magazine Article
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