• 
  

  • Pain relief.

  
  

  • Management of infection.

  
  

  • Prevention of recurrence.

Specific Indications for Surgical Treatment

• 
  

  • Stage I.

  
  
  
  
  • 
    

    • Description: Focal pain, erythema, and swelling at lateral margin of the nailbed.

    
    

    • Treatment: Conservative management.

  
  

  • Stage II.

  
  
  
  
  • 
    

    • Description: Worsening inflammation and infection and formation of purulent granulation tissue.

    
    

    • Treatment: Conservative management or angular nail resection with debridement.

  
  

  • Stage III.

  
  
  
  
  • 
    

    • Description: Chronic and severe disease state with lateral wall hypertrophy.

    
    

    • Treatment: Partial nail resection or total nail avulsion.

Relative

• 
  

  • Underlying conditions that could complicate wound healing (eg, immunosuppression, diabetes). Referral to specialty clinics may be appropriate for patients with such conditions.

• 
  

  • 1–2% lidocaine without epinephrine.

  
  

  • Alcohol pads.

  
  

  • 10% povidone-iodine/antiseptic cleanser.

  
  

  • Syringe with 25- or 27-gauge needle.

  
  

  • Digital tourniquet.

  
  

  • Sterile gauze (4 × 4).

  
  

  • Sterile towel and drapes.

  
  

  • Sterile cotton or petrolatum gauze.

  
  

  • Nail cutter or splitter.

  
  

  • Hemostats.

  
  

  • Scissors.

  
  

  • Antibacterial ointment.

  
  

  • Silver nitrate sticks.

  
  

  • Nail file.

  
  

  • Scalpel #11.

• 
  

  • Bleeding, which can be reduced by the use of a tourniquet for hemostasis.

  
  

  • Pain, which can be alleviated by using a digital block for anesthesia.

  
  

  • Recurrence of ingrown toenail.

  
  

  • Absent or abnormal regrowth of the nail, resulting from aggressive debridement.

• 
  

  • Use a tourniquet around the affected toe to provide additional hemostasis.

  
  

  • Choose conservative treatment with oral antibiotics and warm soaks whenever possible.

  
  

  • Instruct the parents about maintaining good foot hygiene (eg, trimming the nail transversely) and advise that the child wear loose footwear as much as possible.