Ingrown toenail

When should patients follow up for an evaluation?

1 week unless concerns of infection

In a partial toe nail removal, what are 5 steps done after the toe nail is actually removed (closing steps)?

1. Examine nail bed for debris or splinters 2. remove tourniquet 3. cauterize matrix (optional) 4. Apply antibiotic ointment to nail bed 5. cover with sterile dressing

What are 5 other causes of an ingrown toe nail?

1. cutting nail at a rounded angle 2. accumulation of debris 3. congenital malformation 4. curling or deformity due to trauma or excessive growth 5. poor fitting shoes

What are the 7 simplified steps for a partial ingrown toenail removal (prep and resection)?

1. prepare sterile field 2. digital block wait 5-20 min 3. add tourniquet around proximal toe (optional) 4. file upper surface of the middle third of the nail until you can see the nail matrix 5. elevate nail with upward pressure and away from nail bed to minimize bleeding and injury 6. grasp the wedge with hemostat 7. In one steady, continuous motion, pull the wedge off with simultaneously twisting toward the affected side of the toe

How does the total nail removal differ from the partial (3)?

1. thin both nail edges (lat and medial) 2. use scissors to cut down the center of the affected nail 3. loosen & remove one side of the nail at a time

How long should a patient wait until they can walk following a ingrown toenail removal? What shoes should they wear?

24 hours open-toed or sandals

When should full healing be achieved from an ingrown toenail removal?

4-6 weeks

How is anesthesia administered with an ingrown toenail resection?

Digital Nerve Block

Which toe most commonly has ingrown toenails? Is the lateral or medial side more commonly affected?

Great toe; lateral side

What is is the medical term for an ingrown toenail?

Onychocryptosis

Which stage is the following ingrown toenail in and how is it managed? tenderness to palpation and with wearing shoes. Erythema and slight swelling at the site

Stage I; warm soaks, cotton wick elevation of affected nail corner, antibiotics if infection

Which stage is the following ingrown toenail in and how is it managed? erythema and tenderness associated with suppuration and a small collection of pus

Stage II; Partial toe nail removal

Which stage is the following ingrown toenail in and how is it managed? pain, redness and heat at the nail edge, lateral nail-fold hypertrophy with granulation tissue, pus collection

Stage III; debride nail groove silver nitrate cautery to hypertrophied nail complete nail avulsion or wedge resection of distal nail edge Electrosurgical matricectomy Surgical excision of nail plate, bed and matrix

Which age group and gender do ingrown toenails commonly affect?

adolescent males

You have a patient appear with purulent discharge around their ingrown toenail. What conditions may occur if treatment is delayed?

cellulitis lymphangitis

What is the underlying cause of inflammation and infection with ingrown toenails?

foreign body reaction to the nail entering the sulcus and subcutaneous tissue

____________ tissue can occur with irritation of an ingrown toenail. What are the problems with this occuring?

hypergranulation; protrudes over nail highly vascular

What are three complications of ingrown toenail removal?

infection excessive bleeding nail regrowth with paronchyia

What are 5 predisposing causes for an ingrown toenail?

involuted toenails shape of nails-- broad at distal edge, large nail plate skin texture toe size onychotillomania (splints nails)

What other condition should be looked for when examining an ingrown toenail?

onychomycosis

What causes periungal tissue to become inflamed with an ingrown toenail?

penetration by the nail spike

What should be included in a vascular status inspection of an ingrown toenail?

pulse temp color ABI

How does the periungal tissue appear with ingrown toenails?

red, hot, swollen and shiny

What are the treatment goals of an ingrown toenail (3)?

removal of nail spike reduce infection if present healing tissue

What are the two short term outcomes in a ingrown toenail removal?

serosanguineous drainage minimal within 24 hours pain well-controlled with non-narcotic analgesia and elevation

What are three indications for nail removal?

trauma onychomycosis ingrown toenail