title: Surgical treatment of ingrown toenails in children: what is best practice?
abstract: BACKGROUND
  Surgery for ingrowing toenails carries a significant re-operation rate. We reviewed our departmental figures to assess the optimal management of these patients.
  
  
  METHODS
  We performed a 10-year retrospective review of all patients undergoing surgery for  ingrown toenails (IGTN) in order to determine the operations most commonly used and the re-operation rate of each of these procedures.
  
  
  RESULTS
  A total of 880 procedures were performed on 414 patients. The median age at operation was 8.5 years. About half (48%) of children underwent two  or more procedures with wedge excision and phenol application being the most common initial and repeat procedure. Recurrent surgery was most likely following plain avulsion or wedge avulsion without phenol application. Excision of the nailbed with phenol application had the lowest recurrence  rate at 18.4%.
  
  
  CONCLUSIONS
  We recommend wedge resection with phenol application as first-line treatment with simple avulsion reserved for severely infected toes. Total nail bed excisions should be reserved for patients with significant on-going morbidity associated with IGTN. Families  must be made aware of the likely outcome of IGTN surgery and the choice of operation must be tailored to the individual.
authors.affiliation: Department of Paediatric Surgery, Royal Hospital for Sick Children, Edinburgh, UK. sarahannemitchell@hotmail.co.uk
authors.forename: S
authors.initials: S
authors.lastname: Mitchell
authors.forename: C R
authors.initials: CR
authors.lastname: Jackson
authors.forename: D
authors.initials: D
authors.lastname: Wilson-Storey
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009263:Nails, Ingrown / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors