Combination therapy for recurrent ingrown toe nail

Abstract

Ingrown toe nail is one of the commonest foot lesion affecting young individuals. The recurrence rate with a variety of treatment modalities continues to be quite significant. Hence the need to develop a comprehensive combination therapy to reduce the recurrence rate. Onychocryptosis or ingrown toe nail is a common and painful form of nail disease. It affects adolescents and young males very commonly. A combination therapy comprising of wedge resection of the nail, matricectomy, phenol cauterization and wedge excision of hyper granulations for recurrent advanced presentation of ingrown toe nail is presented.  A 32-year-old male with a history of recurrent ingrown toe nail, operated twice previously presented with an advanced stage of ingrown toe nail. Hypertrophic granulation tissue covered both lateral and medial nail plates. The patient was treated with an integrated surgical approach comprising of wedge resection of medial as well as lateral border of nail ensuring removal of spicules on either side, followed by wedge resection of underlying nail bed. This was followed by phenol cauterization and elliptical excision of hypertrophic granulations. The predisposing factors, natural history and treatment modalities are discussed. Combination therapy is a safe and the best option for recurrent ingrown toe nail. It can also be used as a form of primary treatment in fresh cases to prevent recurrence.