Surgical Strategies for Ingrown Toenails- A Comprehensive Review of Techniques, Outcomes, and Advancements, page 1
THE ZADIK PROCEDURE- A CASE STUDY, page 1
- Anaesthesia
- Digital nerve block with local anaesthetic (usually without adrenaline)
- Apply digital tourniquet at base of toe
- Surgical Steps
- Nail plate removed from the nail bed
- Prep the nail bed with iodine
- Make a small cut at the corner of the nail base (lateral nail fold) to access the proximal matrix an raise an H shaped flap
- Draw the flap back
- Excise a rectangle of the which includes the germinal matrix down to the underlying phalanx making sure to go medial and lateral enough to prevent spicule formation
- Closure
- Proximal nail fold flap is advanced to the nail bed, secured with simple interrupted polypropylene sutures, applying minimal tension to preserve flap viability
- Postoperative Care
- Non-adherent dressing
- Elevation of foot
- Antibiotics if signs of infection
- Wound care with regular dressing changes until healed
- Advantage is that in about 60% patients sterile matrix will continue to form flaky keratin masses that cosmetically looks like a “nail”
- Recurrence as low as 4%
