Permanent Ingrown Nail Procedure: Matrixectomy

An ingrown toenail occurs when the edge of a toenail grows into the surrounding skin, causing pain, swelling, and sometimes infection. This condition most commonly affects the big toe and can result from various factors, including improper nail trimming, tight footwear, injury, or genetic predisposition. While conservative treatments such as soaking the foot, wearing proper footwear, and careful nail trimming can often manage mild cases, severe or recurrent ingrown toenails may require a more permanent solution. Surgical matrixectomy is a procedure designed to remove a portion of the toenail matrix, the tissue responsible for nail growth, to prevent the problematic section of the nail from growing back. This provides a long-term solution to chronic ingrown toenails.

The Procedure

The surgical matrixectomy procedure involves removing part or all of the toenail matrix to stop the regrowth of the ingrown portion of the nail. Here’s an overview of the key steps involved:

  1. Preparation and Anesthesia: The procedure is usually performed under local anesthesia. The toe is numbed to ensure the patient does not feel pain during the surgery.

  2. Incision and Nail Removal: An incision may not always be necessary, as the procedure typically involves working through the existing nail. The surgeon will carefully lift and trim the ingrown portion of the nail.

  3. Matrix Removal: The critical part of the procedure is destroying or removing the nail matrix to prevent regrowth. The nail matrix is surgically excised using a scalpel.

  4. Closure and Dressing: After the matrix has been removed or destroyed, the area is cleaned, and a sterile dressing is applied to the toe. No sutures are typically needed, and the toe is bandaged.

Recovery from a surgical matrixectomy typically involves keeping the foot elevated, applying ice to reduce swelling, and avoiding strenuous activities for a few days. Patients should keep the surgical site clean and dry. Wearing open-toed or loose-fitting shoes can help reduce pressure on the toe. Most patients experience significant relief from the pain of ingrown toenails after recovery, with a low likelihood of recurrence if the matrixectomy is successful. Follow-up appointments are important to ensure proper healing and to address any concerns promptly.

Possible Complications Related to Matrixectomy Surgery

Incomplete Matrix Removal

If the entire nail matrix is not adequately destroyed or removed, the nail may regrow, possibly leading to a recurrence of the ingrown toenail.  Although a great amount of precision and attention to detail are used for this procedure, if a few cells are left in the region (which is impossible to visualize), there is a chance a recurrence will occur.  Sometimes, the nail does not grow back, but a thin sliver of nail referred to as a “spicule” can grow as a result of remnant cells from the matrix. This complication is manageable and can be treated.

Unexpected Result

In rare instances, the nail can respond poorly to the procedure and will become thin, or curved in shape.  Depending on the extent of the matrixectomy, the nail may grow back thinner, shorter, or not at all. In partial matrixectomy cases, the nail might appear narrower.