Surgical treatments for ingrowing toenails
Abstract
Background
Ingrowing toenails are a common condition which, when recurrent and painful, are often treated surgically.
Objectives
To evaluate the effectiveness of methods of the surgical treatment of ingrowing toenails.
Search methods
Electronic database searching (CENTRAL, MEDLINE, EMBASE, CINAHL) followed by investigation of reference lists of the papers identified from the initial search.
Selection criteria
Any randomised (or quasi‐randomised) controlled trial which compares one form of surgical removal of all or part of a toenail due to its impact on the soft tissues to another or others. Studies must have a minimum follow period of six months and aim to permanently remove the troublesome portion of the nail.
Data collection and analysis
Data extraction was carried out independently by the two authors using a pre‐derived data extraction form and entered into RevMan. Categorical outcomes were analysed as odds ratios with 95% confidence intervals.
Main results
Avulsion with phenol versus surgical excision
Phenolisation combined with simple avulsion of a nail is more effective than the use of more invasive excisional surgical procedures to prevent symptomatic recurrence at six months or more (OR 0.44; 95% CI 0.24 to 0.80).
Avulsion with phenol versus avulsion without phenol
The addition of phenol, when performing a total or partial nail avulsion dramatically reduces the rate of symptomatic recurrence, (OR 0.07; 95% CI 0.04 to 0.12). This is offset by a significant increase in the rate of post‐operative infection when phenol is used (OR 5.69; 95% CI 1.93 to 16.77).
Authors' conclusions
The evidence suggests that simple nail avulsion combined with the use of phenol, compared to surgical excisional techniques without the use of phenol, is more effective at preventing symptomatic recurrence of ingrowing toenails.
The addition of phenol when simple nail avulsion is performed dramatically decreases symptomatic recurrence, but at the cost of increased post‐operative infection.
PICOs
Plain language summary
Surgical interventions for ingrowing toenails
Ingrown toenails occur when the skin at the side of a nail is punctured or traumatised by the growing nail. This causes inflammation and sometimes infection. After removing part or all of the nail causing the problem, options to prevent recurrence include removing the nailbed and/or applying phenol (a caustic liquid). The review of trials found that removing the ingrown nail and using phenol on the nailbed was more effective at preventing recurrence than nailbed removal. However, people whose nailbeds were treated with phenol were more likely to have infections than those whose nailbeds were untreated after the surgery.
