injuries poisoning
How To Treat an Ingrown Toenail
Step by Step Description of Treating an Ingrown Toenail
Several procedures can be done. Some involve only separating and isolating the nail fold from the nail (splinting the nail). Others involve removing part of the nail, either the lateral margin, or a spike-like segment of nail (spicule) growing adjacent to the lateral margin; spicules can develop as a complication of treatment or spontaneously. Sometimes, nail fold tissue is removed. Removal of the entire nail is no longer considered beneficial. Cleanse the site withpovidone-iodineorchlorhexidinesolution. Do a digital block to fully anesthetize the toe. Apply a tourniquet at the base of the toe to control bleeding. Determine extent of treatment based on degree of local soft-tissue inflammation or infection. If inflammation is minimal, consider splinting the nail or removing only a nail spicule. If inflammation is more extensive or for infection (particularly chronic) or severe pain, remove part of the nail. Elevate the lateral border of the nail with forceps or a hemostat. Insert a cotton pledget (for mild inflammation), wound closure strip (for moderate inflammation), or 1-cm long strip from a 2- to 3-mm diameter surgical drain under the lateral nail edge. Insert wound closure strips and surgical drain material, obliquely under the corner of the nail with a to-and-fro sawing motion until the corner is sufficiently elevated and is under the entire length of the nail. Secure a tape closure around the toe. If necessary, elevate the nail spicule with forceps or a hemostat. Use the nail splitter or sharp-pointed scissors to cut longitudinally between the spicule and the nail plate continuing through the origin of the spicule, about ⅓ to ½ the way under the cuticle to the base of the nail. Twist the nail spicule from the nail bed with a forceps or hemostat. Remove any debris from the nail fold. Control bleeding usingsilver nitrate. If an abscess is present, drain all pus, irrigate any cavity, and dress the toe. Use the nail splitter or sharp-pointed scissors to elevate the lateral 3 to 4 mm of the affected margin of the nail from the nail bed. Advance the splitter or point of the scissors parallel to the nail bed and go all the way to the proximal nail fold (cuticle). Cut the nail lengthwise to separate the elevated segment, being sure to also cut the portion of nail under the cuticle. Grab the segment of nail with forceps or a hemostat back close to the root and twist the segment root toward the rest of the nail, eventually freeing it from the nail fold and cuticle. Gently retract the nail fold and cleanse the dermis or epidermis of any hidden debris. Apply asilver nitratestick to control any bleeding. Consider applyingsilver nitrateto the exposed nail bed and granulation tissue for 2 minutes because this tends to prevent nail regrowth. If available, consider applying 10% sodium hydroxide (for 1 to 2 minutes) or 1%phenolsolution on cotton-tipped applicators (3 applications, each about 30 seconds, or a single 5-minute application) to the exposed nail bed to permanently inhibit nail regrowth. 