Editing Ingrown toenail (section)

== '''Wedge resection:''' ==

* Aim to excise about a quarter of the nail, the nail fold, the nail wall and nailbed
* Ring block
* Glove tourniquet
* Mobilise and excise about a quarter of the nail on the affected side (3-5mm), using Gillies and Metz scissors. Avoid lifting the nail too much in the middle, as that needs to stay intact and attached.
* Lift the nail fold by making an oblique cut at the base of the nail. Options to destroy germinal matrix:
** Excise with scalpel
*** The stuff you need to get rid of is the whitish tissue - basically cut down to bone
** Apply 88% phenol (be very careful not to get any on skin) - Cochrane review demonstrated much lower recurrence rate. Apply paraffin to skin to protect it. Clean skin and apply alcohol to skin afterwards. 
** Diathermy
** Curette
* Close the cut with a single Prolene suture
* Jelonet on top of nail, gauze, crepe
* Review in clinic 2/52 
** Dressing off
** Clean
** Suture out
* Patient can then commence betadine soaks daily and go back to wearing loose shoes