ingrown toenail avulsion; Zadek's procedure
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Indications
Procedure
- equipment
- anesthesia
- cautions
- diabetes mellitus
- immunocompromised patients
- patients with circulatory disease
- technique
- apply field block of the toe & wait 10 minutes for anesthesia: infected nails are tender
- prepare skin with povidone-iodine or Hibiclens
- apply a few layers of gauze around the base of the toe to protect digital neurovascular bundles, followed by application of a Penrose tourniquet, held with hemostat to ensure bloodless field
- free portion of nail plate from nail bed & matrix with septal elevator or straight mosquito hemostat
- grasp spicule with hemostat & avulse by rotation toward main nail plate
- curette proximal nail matrix & any granulation tissue present
- phenol:
- protect surrounding skin with antibiotic ointment
- apply fresh phenol (88% carbolic acid) to base of nail to ablate any remaining matrix & assist in hemostasis
- use 3-soaked applicator sticks for 1 minute each (with pressure)
- electrocautery is an alternative to phenol
- remove hypertrophic nail fold by wedge excision if indicated & suture skin edge to remaining nail plate
- remove tourniquet, apply antibiotic ointment to wound followed by non-adherent dressing
- follow-up
- elevate foot & apply ice for initial bleeding & pain
- opiate analgesics for 2-3 days
- 1st redressing in 4-7 days or as needed for bleeding
- serous drainage from phenol treatment is expected
- healing is generally complete in 4 weeks
- spicule regrowth is common, regardless of the method requiring a 2nd albiet lesser procedure
More general terms
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 985-86