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What is Ingrown Toenail Wedge Resection?

An ingrown toenail is a common and painful condition of the toe. It occurs when the side or corner of the nail grows inwards and penetrates the skin of the toe. Pain is often accompanied by swelling and redness. The big toe is affected most often.

An ingrown toenail wedge resection or excision, also called a partial nail avulsion, is a surgical procedure to treat an ingrown toenail condition. The procedure involves the removal of a section of the toenail to prevent it from digging into the skin.

Indications for Ingrown Toenail Wedge Resection

Ingrown toenails occur most often due to wearing ill-fitting footwear or improper trimming of the nails. Untreated ingrown nails can lead to infection or even an abscess that necessitates surgical treatment. Conservative treatment is the first line of treatment for an ingrown toenail and may involve soaking the affected foot regularly in warm water, taking antibiotics and pain relievers, wearing footwear that comfortably fits the shape of your feet, and in some instances, wearing a special splint to prevent the toenail from growing deeper into the skin. However, if these conservative measures fail to provide the desired results or the symptoms associated with an ingrown toenail, such as pain, swelling, and redness continue to persist, your doctor may recommend a wedge resection as a surgical remedy.

Preparation for Ingrown Toenail Wedge Resection

Preparation for ingrown toenail wedge resection surgery may involve the following steps:

  • A review of your medical history and a physical examination are performed by your doctor to check for any medical issues that need to be addressed prior to the surgery.
  • You may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could compromise the safety of the surgery.
  • You should inform your doctor if you have allergies to medications, anesthesia, or latex.
  • Prescription oral antibiotics may be given if you have an ingrown toenail infection. Make sure to take it according to your physician’s specific pre-operative and post-operative instructions.
  • You are advised to wear open-toed footwear as thong-style flip-flops with staps in between the toes can make surgical dressing uncomfortable and hinder the healing process.
  • You are advised to arrange for someone to drive you home after the surgery.
  • Written consent will be obtained from you after the surgery has been explained in detail.

Procedure for Ingrown Toenail Wedge Resection

Wedge resection for an ingrown toenail is a minimally invasive surgery and is performed in an outpatient or inpatient setting based on the severity of the condition. In general, the procedure involves the following:

  • Local anesthesia is administered to the affected area so that you do not feel any pain.
  • An incision is then made through the length of your affected nail.
  • A second incision is made along the outside edge of the nail meeting the first incision at both ends.
  • The incisions are deepened to meet underneath the nail, and the infection is drained.
  • The wedge of the nail and a little bit of flesh between the 2 incisions is then removed.
  • Following this, the wound is typically closed by employing a dissolvable stitch.
  • The whole surgery may take anywhere from 15 to 20 minutes.

Postoperative Care and Recovery

Immediately following the surgery, your toe will be wrapped in a bandage to protect the wound, facilitate healing of the incisions, and prevent infection. You should avoid weight-bearing on the affected foot and keep your foot elevated for about a day or two. You are normally able to return to your usual activities the day after and are given instructions for pain medications and wound care if needed. Most patients are prescribed antibiotics, which can either be topical or oral, to prevent an infection. You may also be advised to wear open-toed sandals or comfortable shoes during the first few days following the procedure.

Risks and Complications

Ingrown toenail wedge resection surgery is a relatively simple and safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:  

  • Infection
  • Bleeding
  • Adverse reaction to anesthesia
  • Narrowing of the toenail
  • Numbness
  • Swelling
  • Pain and discomfort
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