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Operative Treatment of Ingrown Toenail by Nail Fold Resection Without Matricectomy

Michael B. DeBrule Midwest Podiatry Centers, 6600 Lyndale Ave, Suite 130, Richfield, MN 55423. (E-mail: mdebrule@midwestpodiatrycenters.com)

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Background

Many operative techniques have been studied for correction of ingrown toenails, yet the role of nail fold resection without matricectomy is poorly defined. Current literature on this topic is sparse, and previous systematic reviews are absent.

Methods

A MEDLINE/Cumulative Index to Nursing and Allied Health Literature/Scopus search was performed and a systematic review was undertaken for articles discussing surgical treatment of ingrown toenail by nail fold resection without matricectomy. Outcome measures were systematically reported, and variations in operative technique were identified.

Results

Of the 14 articles that fit the inclusion criteria, 2 were level V evidence, 11 were level IV, and 1 was level III. Minimum follow-up time and the criteria for a satisfactory outcome were not consistently defined. Recurrence rates varied from 0% to 20%. The postsurgical infection rate was 0% for all nine studies reporting infection. Ten different operative techniques were identified. Three studies used partial or total nail avulsion as an adjunctive operative procedure. Triangular-, crescent-, elliptical-, semi-elliptical–, and radical-shaped skin excision strategies were identified. Primary and secondary intentions were used for closure.

Conclusions

Operative algorithms for the treatment of ingrown toenail are still unclear regarding nail fold resection without matricectomy and are supported by almost entirely level IV evidence. Future prospective comparative studies and randomized trials are necessary to support and strengthen current practice.