Partial Nail Avulsion

General remarks

Partial nail avulsion with phenolization gives better results than partial avulsion with matrix excision in terms of recurrence rates. Use of phenol does not produce more signs of infection than matrix excision. For the treatment of the ingrown toenail it is recommended to perform a partial nail avulsion with phenolisation.

The use of local antibiotics does not reduce signs of infection or recurrence and should therefore not be used routinely.

Step by step

1. Create aseptic environment
2. Local anaesthesia (without epinephrine)
3. Apply rubberband
4. Release eponychium and lateral side
5. Cut complete nail (proceed under the cuticle), when the proximal edge is cut a 'give' can be felt
6. Grasp as much nailplate into needledriver or hemostat
7. Remove nailplate by gentle traction and rotating outward
8. Check if complete nail root has been removed
9. Clean matrix and lateral border
10. Apply protective petroleum jelly on skin
11. Insert cotton swab with phenol and apply gentle pressure and rotate inward for 60 seconds
12. Rinse and neutralize with alcohol 70%
13. Repeat phenol-alcohol procedure once
14. Clean wound
15. Remove rubber band!
16. Apply pressure bandage

References	Ingrown Toenail Removal. Zuber TJ. Am Fam Physician.2002 Jun 15;65(12):2547-52, 2554. Surgical treatments for ingrowing toenails. Rounding C, Bloomfield S. Cochrane Database Syst Rev.2005 Apr 18;(2):CD001541. Randomized clinical trial of surgical technique and local antibiotics for ingrowing toenail. Bos AM, van Tilburg MW, van Sorge AA, Klinkenbijl JH. Br J Surg. 2007 Mar;94(3):292-6