An ingrown toenail is when the side of the nail grows into the skin of the toe. This most commonly happens to the big toe.
Surgery is required when this problem does not go away (chronic) or if it keeps coming back (recurrent)
Surgery for an ingrown toenail usually involves cutting the part (wedge) of the nail that is digging into the adjacent skin. However, removing the nail only may result in the problem coming back in the future when the nail grows back. For this reason, a wedge of the “nailbed” is also removed. This is the tissue where the nail grows from.
The procedure is performed in the operating theatre either under local or general anaesthetic.
During the surgery a tourniquet (like a rubber band) is placed around the base of the toe to stop bleeding during the operation. The ingrown edge of the nail is cut. A small oblique incision is made at the corner of the skin on the same side of the nail. This cut allows access to the nail-bed. A wedge of nail-bed is then excised down to the bone. This prevents regrowth of the nail.
The skin cut is sutured with a non-dissolving stitch which is to be removed 7-10 days later. A dressing of multiple layers is placed over the toe. The layers are in this order from inside out:
- Jelonet – This is a waxy gauze which prevents the overlying dressings from sticking to the wound.
- Melolin – An absorbent dressing which also has a non-stick surface.
- Crepe bandage – this provides pressure which prevents bleeding after the tourniquet is removed. It stays on for 24 hours.
- Tape – This secures the bandage in place.
The dressings are all removed after 24 hours – usually at your GP clinic. It is replaced with a simpler dressing that no longer has to provide pressure.
What are the risks of surgery?
Minor ooze of blood into the dressing is normal. Significant bleeding is unlikely especially if the pressure bandage has been placed adequately. If you experience minor ooze of blood through the dressing, you can reinforce it with gauze and apply direct pressure for a few minutes. If significant bleeding through the dressing continues, you should seek medical attention (contact us, see your GP or go to the emergency department).
To prevent infection after surgery, it is important that you keep your foot clean and dry. It is also important to have the dressing changed after 24 hours.
If your toenail was infected prior to surgery, you may be given a course of antibiotics for 5-7 days after surgery.
Despite removing the nailbed, regrowth of the nail may rarely occur.
Fast from midnight for a morning procedure OR from 7am for an afternoon procedure.
If your procedure is being carried out under local anaesthetic in the rooms, you do not have to fast.
You will be contacted by the hospital the day before your procedure to let you know what time to come in.
This is usually 1-2 hours before your surgery.
- Take regular Panadol (as long as there are no medical reasons for you not to take it such as an allergic reaction or liver disease).
- Non-steroidal anti-inflammatory medication such as Neurofen and Voltaren can also help with pain and inflammation but should be taken on a full stomach. Take these for the first 3-5 days as required.
- Stronger pain killers such as opioid anaelgesics (Endone, Codeine) should be taken sparingly as they can cause constipation.
In the first 24 hours after your surgery, you should keep your foot elevated for as long as possible and avoid putting pressure on the toe while walking.
The pressure bandage around your toe is to stop bleeding. It should be tight enough to stop bleeding but not too tight to stop blood flow to the toe. If the bandage feels too tight, remove it.
The primary dressing needs to be changed within 24 hours. All of the dressings are removed. No further pressure bandages are required. The dressing is changed to a simple non-stick dressing.
The dressings are not waterproof and should not be wet for the first 5 days. You can use a plastic bag around your foot during a shower. If the dressing gets wet, you should change it.
You can go home the same day.
Sutures are removed in 7-10 days. This can be done at your GP clinic or at your follow up appointment.
Your follow up appointment will be made for you 1-2 weeks after your surgery to review the wound.