A toenail excision is when the toenail and sometimes the nail bed from which the toenail grows is removed surgically or destroyed. This procedure is typically used to treat ingrown toenails and thickened toenails which do not respond to other treatments. The out-patient surgery is fairly simple and does not require extensive follow up care.
Ingrown toenails or thick toenails are the two most common problems treated with a toenail excision. An ingrown toenail occurs when the edge of the nail grows into the skin surrounding the nail, causing pain, swelling, and often infection. A thickened nail usually develops from a fungal infection of the nail bed. When an ingrown toenail recurs or the fungal infection in the nail bed does not respond to drug treatments, a toenail excision is a way to permanently prevent these problems.
The first step in a toenail excision is to numb the area with a local anesthetic, and sometimes the blood flow to the toe is decreased with a tourniquet. Next, the fold of skin surrounding the nail is loosened so that the nail can be removed. If the patient does not want the nail to grow back, the nail bed will be destroyed using an abrasive chemical, such as phenol, by surgically excision or a laser. Finally, the doctor will clean the area, and apply an antibiotic cream and a bandage.
Wherever the nail bed is removed during a toenail excision, the nail will not re-grow. Some patients will only have the nail bed removed on the frequently ingrown side of the toenail so that the other half of the toenail will remain and grow to protect the top of the toe. For other patients, the whole nail bed will be removed and a toenail will no longer grow. This situation does not cause any problems and usually is not noticeable.
At-home care following the procedure will be outlined by the doctor and should be carefully followed to avoid infection. For the most part, this will involve rest and elevation for the first 24 hours. The wound can either be washed in the shower or soaked in a footbath, followed by a fresh application of antibiotic ointment and a bandage. Comfortable, loose shoes will need to be worn, and running or excessive physical exercise should be avoided for at least two weeks after the procedure. The patient will need to examine the wound daily for any signs of infection, such as redness, swelling, increasing pain, heat, or excessive discharge.