Ingrowing Toe Nail Surgery

Added: 2026-05-17

[00:00:05]Hello guys, today I'm going to take you through an operation in which we are going to take do surgery for ingrowing toenail. This gentleman is bothered by repeated pain and infection.

[00:00:16]So my plan is to take the nail away, burn the nail bed and cauterize with chemical as well as electrocautery so that his symptoms could be made better. It's a straightforward procedure. I will still I try to break it into steps so that you can do this procedure at ease in your practice.

[00:00:34]So this is our patient uh uh ready. We have painted and draped.

[00:00:40]And I've given some local anesthetic spray on the skin to see if I can make um the block slightly less painful.

[00:00:48]Now it it's a very straightforward operation. They're not um a lot of equipment required. There are specialist equipment which are needed to do this procedure but I don't have access to those. I'm just going to use very basic things um which should be available with all of you uh should you wish to do this procedure. So next thing will be I'll show you how I um you know, anesthetize this area so that we can do this procedure under local anesthetic.

[00:01:18]So I've taken around 5 to 8 ml of 2% and I have diluted it uh some saline to increase the volume.

[00:01:26]And the first thing I will just go is in the web space.

[00:01:30]So just gentle just some local but give go very slow.

[00:01:37]Give some [snorts] time for local anesthetic to act.

[00:01:46]This will make it less painful to the patient.

[00:02:04]So just keep going.

[00:02:16]I think that should be enough.

[00:02:19]Now if you see here this area is already under effect of anesthesia.

[00:02:24]So what I do is there are always if you just go here and here you still have some area where it still leads to some discomfort. So just avoid the pain. If you just go and enter from this area which is already anesthetized and then just keep pushing the local anesthetic forward.

[00:02:43]Just keep moving the needle.

[00:02:46]Keep it forward.

[00:02:50]Can you see it? Now from there to there.

[00:02:52]So the only prick that the patient has felt was this.

[00:02:54]And even that I have used some local anesthetic spray to make it as less painful as possible for the patient. And the key is to go slow.

[00:03:02]Give time for tissues to take the local anesthetic that you have given.

[00:03:10]So first prick was here, second prick was here. Now you can see I've infiltrated local anesthetic up to roughly here. So I'm just going to enter from here.

[00:03:19]Again because this is already anesthetized patient will not feel a thing.

[00:03:25]And then keep slowly going.

[00:03:28]And then as you you keep going keep going deep.

[00:03:52]So this was my first prick, this was my second prick, third prick and then he was still complaining of some pain so I gave some local here as well but now it is virtually pain free.

[00:04:02]I'm pressing and he's not having any pain so just wait. We have waited at least 5 minutes for the local anesthetic to um take its effect because you don't want the patient to have pain because if the patient will have pain the and then it will have bleeding.

[00:04:20]So now I have cut this tiny Foley's catheter which we are going to use as a digital tourniquet so that our area is bloodless.

[00:04:31]So digital tourniquet is applied. So I aim to resect this much of nail.

[00:04:39]He doesn't have any problems there but if there is bilateral problem you can resect the other side as well but on this occasion I'm just going to resect that.

[00:04:46]So the first thing that I'm going to use is my McDonald's.

[00:04:51]McDonald will just use is just to lift it up from the nail bed.

[00:05:04]So use McDonald slowly to elevate the nail off the nail bed.

[00:05:15]So this is how you will do it.

[00:05:20]And once nail bed is elevated I will join you back.

[00:05:26]Ideally you should not be doing this procedure when there is infection but I gave this gentleman a few weeks of antibiotic but still he has some residual infection.

[00:05:37]So this was the best he was going to get.

[00:05:41]So just slowly I'm just going and elevating the nail.

[00:05:45]And I think I've gone enough.

[00:05:47]And once I've got enough you need something to cut this much of nail.

[00:05:53]So this is the nail [snorts] bed.

[00:05:59]The nail have elevated it.

[00:06:02]And I'm quite happy with the depth that I have taken so it's virtually gone there.

[00:06:07]So that's what I want.

[00:06:09]So that's gone there.

[00:06:14]So on this occasion you know, I don't have the specialist equipment which are small very tiny which looks exactly like this. I'm just aiming I'm just using the bone cutter just to start the cut. [snorts] But if you don't have you can use that with a you can use it. So this is not working.

[00:06:33]So I'm just going to use a knife which everybody should have in order to start and cut the nail. So I'm just going to use a knife.

[00:06:51]And then I'm going to cut the nail.

[00:06:58]So I slit the nail with the knife and then you can use a sharp scissor to just cut this.

[00:07:14]That looks cut.

[00:07:22]Now once I've cut this I'm just going to hold it and then pull the nail out.

[00:07:35]So I'm just going to pull the nail out.

[00:07:41]So you can see this.

[00:07:43]This has come out.

[00:07:48]So even though he had two previous operations the outside of this nail but this nail was still coming up.

[00:07:54]This we have taken out.

[00:07:56]Now once we have taken this out it we need a thin cot curette. So I'll just have a thin curette.

[00:08:07]So if you can have grab if you don't have in orthopedic theater I have asked one of this from ENT.

[00:08:13]And then curette it.

[00:08:15]Curette the germinal matrix.

[00:08:19]That's it. That's like that.

[00:08:22]And you can see that the nail this procedure is not painful and it is virtually bloodless because of the digital tourniquet.

[00:08:37]So I'm just using this curette.

[00:08:40]And you will feel where there is matrix you will feel bone. You will feel like you are grating or you are rubbing on the bone.

[00:08:47]So just rub it and keep you need to destroy the germinal matrix of the nail bed so that the nail doesn't come back.

[00:09:00]That's it. That looks pretty good.

[00:09:06]Now I think most cases I don't reflect this. I don't think it's needed but if you want you can make an incision here and you can visibly see the germinal matrix but I think this gives you enough access. So this looks pretty good.

[00:09:20]I'm quite happy that I have taken the germinal matrix on the medial side off. It's completely off. So I have curetted it quite good.

[00:09:30]Now the next thing is the chemical cauterization.

[00:09:33]So you can use phenol.

[00:09:38]So normally I would like to use phenol.

[00:09:40]Phenol unfortunately today was not available but we have got silver nitrate.

[00:09:44]So we just take a swab and we just going to put it inside and leave it there.

[00:09:55]And we'll do it around three or four times. We'll just keep on doing this.

[00:10:01]And what it will do is it will cauterize the germinal matrix.

[00:10:10]So, just leave it for a second for 20-30 seconds.

[00:10:15]And then we'll take it out.

[00:10:18]So, normally these are the swabs that are used for microbiology sampling.

[00:10:30]So, what we have done is we have taken the nail off. We have done a physical curettage using a tiny curette.

[00:10:37]And now we are doing chemical cauterization of the nail bed. And this is to ensure that this nail this side of the nail doesn't come back.

[00:10:45]And this gentleman is not bothered by uh the pain and symptoms that he is associated uh that is associated with ingrowing toenail.

[00:10:54]So, this I'm doing it for the third time. And every time I [snorts] will leave it for roughly a minute.

[00:11:02]This is done.

[00:11:03]We're just going to do a sterile uh dressing, release the tourniquet.

[00:11:09]And that should be the end of the procedure.

[00:11:15]So, once you have uh done your cautery you just need to just give it a wash.

[00:11:39]And then we are ready for our dressing.

[00:11:47]So, just apply some gel on it so that when we take the dressing off he doesn't feel a lot of pain when it's coming off. Can I have some Betadine?

[00:12:04]Some Betadine soaked swab.

[00:12:07]And then I just have some more dressing.

[00:12:12]Some well band.

[00:12:15]So, now we have taken the tourniquet off.

[00:12:18]We're just using some sterile cotton.

[00:12:22]And then we use some compression dressing in form of crepe bandage.

[00:12:29]So, I'm just taking a 4-in crepe bandage.

[00:12:34]And I just cut it slightly.

[00:12:38]And then I'm going to take it across the foot so that it doesn't slip.

[00:12:45]>> [clears throat] >> Just gently.

[00:12:48]And [snorts] then that should be it. You ask the patient to keep the leg elevated, but you should always see the toe.

[00:12:56]Never cover the toes or fingers. You need to see whether they are not cyanosed.

[00:13:05]They are not white.

[00:13:07]Otherwise, that can be catastrophic.

[00:13:09]So, that's it.

[00:13:11]That's how you treat an ingrowing toenail.

[00:13:17]So, guys, there were some technical issues in recording. I think uh for some reason the phone memory was up or something because of which the continuity of this video has been broken, but still I've tried my best so as to cover everything. It's a straightforward procedure. Take the nail out um and do a chemical cautery. And most of these patients usually go back to complete normality. So, I hope you like this video. Please give us a thumbs up.

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