Surgical Dermatology

Ingrown Toenail Surgery Singapore

Dr. Liew Hui Min

accredited consultant dermatologist

Ingrown nail surgery is a procedure that performed by a dermatologist addresses nails growing into the surrounding skin, causing pain, inflammation, and potential infection. This procedure involves removing either a portion or the entire nail, along with the nail matrix (the tissue responsible for nail growth), to prevent regrowth of the problematic section. The surgery relieves discomfort and treats infection while creating a permanent solution for recurrent ingrown nails.

Indications Benefits Techniques Preparation Procedure Recovery Risks FAQ

Indications for Ingrown Nail Surgery

Patients experiencing specific nail conditions may benefit from ingrown nail surgery when conservative treatments have not provided relief.

Recurrent Ingrown Nails: When a nail repeatedly grows into the surrounding skin despite conservative management such as proper trimming or footwear modifications.
Infection: Presence of pus, increasing redness, warmth, or drainage from the nail fold indicates infection that may require surgical intervention.
Severe Pain: Persistent pain that limits daily activities or affects gait, making conservative treatments insufficient.
Failed Conservative Treatment: Cases where proper nail cutting techniques, antibiotics, or cold compress have not resolved the condition over several weeks.
Nail Deformity: Structural abnormalities of the nail that predispose to recurrent ingrown edges.

Benefits of Ingrown Nail Surgery

Ingrown nail surgery offers several advantages compared to continuing with temporary conservative measures.

Pain Relief

Removal of the ingrown portion eliminates the pressure against sensitive skin, providing immediate reduction in discomfort after the initial recovery period.
Prevention of Recurrence

Destruction of the nail matrix prevents the problematic portion from regrowing, addressing the root cause rather than just treating symptoms.
Infection Control

Surgical removal of the infected nail portion allows for better drainage and effective treatment of the underlying infection.
Improved Mobility

Elimination of pain allows patients to resume normal walking and physical activities without compensatory gait patterns.
Reduced Need for Repeated Treatment

Partial or complete matrixectomy significantly decreases the need for ongoing treatments or frequent medical visits.

Surgical Techniques

Partial Nail Avulsion with Phenolisation

This technique involves removing only the ingrown portion of the nail and applying phenol to destroy the corresponding nail matrix. The chemical cauterisation prevents regrowth of the treated portion while preserving the remaining healthy nail. The procedure allows for a cosmetically acceptable result with a high success rate for preventing recurrence.

Complete Nail Avulsion

The entire nail plate is removed from the nail bed in cases of severe deformity or infection affecting the entire nail. This technique may be performed with or without matrix destruction by applying phenol, depending on whether permanent or temporary nail removal is desired. Complete removal provides better access for treating infection but results in the temporary or permanent loss of the entire nail.

Wedge Resection

A triangular piece of nail, including the ingrown portion, is removed along with the corresponding nail matrix. The wedge extends from the edge of the nail to beyond the nail matrix to ensure complete removal of the problem area. This preserves most of the nail while permanently eliminating the ingrown portion.

Surgical Matrixectomy

The procedure involves surgical excision of part or all of the nail matrix using a scalpel or scissors. This technique may be preferred in cases where chemical treatments are contraindicated or for precise matrix removal. Sutures may be required to close the wound, resulting in longer healing time compared to chemical methods.

Preparing for Surgery

Medical Evaluation: A thorough assessment of the affected nail and surrounding tissue determines the extent of the ingrown nail and presence of infection. The evaluation includes checking for signs of poor circulation, diabetes, or immune disorders that may affect healing. The doctor also reviews medical history to identify conditions that may increase surgical risks.

Medication Adjustments: Certain medications affecting blood clotting, such as aspirin or warfarin, may need temporary discontinuation before surgery. Antibiotics may be prescribed before surgery if active infection is present.

Fasting Guidelines: For procedures performed under local anaesthesia, fasting is typically not required. Patients can eat normally before the procedure unless specifically instructed otherwise. For those receiving sedation, fasting from food and drink may be necessary for several hours before surgery.

Step-by-Step Procedure

Administration of Anaesthesia

Local anaesthesia is injected at the base of the toe or finger to block nerve sensation. The anaesthetic is administered through small injections on both sides of the digit, requiring a few minutes to take full effect.

Application of Tourniquet

A rubber band or specialised tourniquet is applied to create a bloodless field. This temporary restriction of blood flow makes visualisation easier during surgery and reduces bleeding. The tourniquet remains in place throughout the procedure but is removed before bandaging.

Nail Border Separation

Using specialised tools, the doctor separates the ingrown portion of the nail from the underlying nail bed. This involves carefully lifting the edge and cutting lengthwise from the free edge to the cuticle. The nail splitter or scissors cut precisely along the planned removal line without damaging surrounding tissue.

Nail Portion Removal

The separated nail section is firmly grasped with forceps and removed by pulling toward the free edge. This extraction includes the full length of the nail portion from cuticle to tip. The doctor inspects the area to ensure all targeted nail fragments have been completely removed.

Matrix Destruction

For permanent correction, the exposed nail matrix is treated with a chemical (commonly phenol) or surgically excised. When using phenol, cotton applicators soaked in the solution are applied to the matrix for several minutes, followed by thorough alcohol or saline irrigation. This step prevents regrowth of the problematic nail portion.

Wound Cleaning and Dressing

The surgical site is cleaned with sterile saline or antiseptic solution to remove blood and debris. Antibiotic ointment may be applied before covering with non-adherent gauze and sterile bandaging.

Post-Surgical Care and Recovery

Initial Care (First 24-48 Hours)

Keep the bandage clean and dry, elevating the treated extremity when possible to reduce swelling. Mild bleeding may occur and can be managed by applying gentle pressure to the area. Pain medication, typically over-the-counter analgesics, can be taken as prescribed to manage discomfort during this period.
Activity Restrictions

Limited weight-bearing on the affected foot may be recommended for the first few days after toenail surgery. Regular shoes may be uncomfortable during healing, so open-toed or wider footwear accommodates bandages and reduces pressure on the surgical site. Most patients can return to regular activities within a week, though complete healing takes longer.
Follow-up Care

A post-operative appointment typically occurs 1-2 weeks after surgery to assess healing progress. The doctor examines the surgical site for signs of proper healing or complications requiring intervention. Additional follow-ups may be scheduled if healing concerns arise or to confirm successful resolution.

Potential Risks and Complications

While ingrown nail surgery is generally well tolerated, complications may occur. Infection can develop despite preventive measures, indicated by increasing pain, redness, swelling, or discharge. Phenol burns may affect surrounding tissue during matrix destruction. Some patients experience nail regrowth if matrix destruction was incomplete. Nerve damage can occur, causing numbness or altered sensation. Abnormal tissue growth (spicules) sometimes develops along the nail edge during healing. Permanent nail deformity is possible, especially with complete nail removal.

Frequently Asked Questions

When can I return to work after surgery?

Most patients with sedentary jobs can return to work within 1-2 days after the procedure. Those with physically demanding occupations requiring extensive walking, standing, or enclosed footwear may need 7-14 days before returning. The timing depends on individual healing and pain tolerance.

Will the nail grow back after surgery?

If a partial procedure with matrix destruction was performed, the treated portion of the nail permanently stops growing while the remainder continues normal growth. Without matrix destruction, the nail regrows completely within 3-12 months. Complete regrowth depends on whether a permanent or temporary procedure was selected.

How can I prevent future ingrown nails?

Proper nail trimming techniques help prevent recurrence, including cutting nails straight across rather than rounded. Wearing shoes with adequate toe room prevents pressure on nail borders. Addressing underlying foot structure issues with appropriate footwear or orthotics reduces mechanical forces on nails. Regular foot hygiene and prompt treatment of minor nail issues before they become ingrown also reduce risk.

Dr Liew Hui Min

Dually Accredited Dermatologist In Singapore and the UK

Dr. Liew Hui Min is an accredited consultant dermatologist from the Ministry of Health and the General Medical Council UK.

Her clinical interest includes:

Paediatric Dermatology,
Women’s Dermatology,
General Adult Dermatology.

Having trained in major London Hospitals, Dr Liew returned to Singapore in 2014 as a Consultant at KK Women’s and Children’s Hospital (KKH) where she specialised in paediatric, women, obstetric and vulva dermatology. Currently, Dr Liew practices at The Skin Drs. clinic located at Gleneagles Hospital.

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