Surgical Treatment of Onychocryptosis

Abstract

Proper nail growth is dependent on a host of mechanical factors. Changes to the nail borders and forces affecting growth at the matrix often leads to pathology at the nail/skin interface. When conservative efforts fail there are a variety of surgical approaches and techniques available to the physician including: radical excision, rotational flap, wedge excision, partial nail avulsion (with/without matrixectomy), total nail avulsion (with/without matrixectomy). Treatment is ultimately up to the practitioner, however, the literature shows that nail removal with matrixectomy is the most effective response to a chronic ingrowing toenail. Current methods of treatment for onychocryptosis with matrixectomy are categorized either as a chemical ablation matrixectomy involving phenol or sodium hydroxide, or excisional matrixectomies which involve “cold steel” removal of the offending nail matrix with or without the nail bed. The Winograd and Frost procedures are examples of partial excisional matrixectomies indicated when an isolated nail border is affected. Some presentations may result in the need for total and permanent nail removal. These procedures involve nail plate avulsion followed by total matrixectomy by surgical excision or chemical cautery using phenol. The Zadik and Suppan procedures are examples of total excisional nail removal.