The particular point in this operation is to obliterate the matrix corresponding to the part of the nail removed. It is insufficient to remove only that part of the nail gouging the flesh. Usually one side only is involved, the outer side, and the removal of half the nail will effect a cure.
Employ local anesthesia. Constrict the base and make a circular injection of cocaine or stovaine (Fig. 587).
Remove the Nail: Introduce the sharp point of the scissors under the nail and divide its entire length (Fig. 588). Next seize the diseased portion with a forceps and tear it out (Fig. 589).
Extirpate the Matrix: Uncise the integument of the matrix to be eliminated, with a sharp-pointed bistoury, holding the cutting point obliquely, so that it gets a larger bite deeply than superficially (Fig. 590). The soft parts are thus removed down to the bone (Fig. 591).
A deep cavity is left in the bottom of which the bone may be seen (Fig. 592). This cavity should be packed with sterile gauze and allowed to heal by granulation, which will require two or three weeks. It is advisable to diminish the size of the cavity by a suture, including on one side the skin, and on the other, the subungual tissues (Fig. 593). It will probably give way finally, yet it facilitates repair.
<Callout type="important" title="Critical Step">Ensure that you remove the entire matrix to prevent recurrence of ingrowing toe-nail.</Callout>
REMOVAL OF SEBACEOUS CYSTS: Dissect the sac out without emptying its contents. The dissection will be done with ease only in case all the layers are incised down to the true capsule. If the cyst walls are thick, the contents may be emptied out from the first.
Once the cyst is exposed retract one lip of the skin wound and loosen the attachments by blunt dissection (Fig. 596). Or if the fibrous attachments are loose and tough, divide them with scissors or scalpel (Fig. 597).
There will be some slight hemorrhage from the cavity following the removal of the cyst, but it will be easily controlled by pressure or a hot compress. In case the cyst was emptied in the course of the operation, be assured that all the cyst wall is removed, or the growth will recur.
The procedure is the same in the case of a fatty tumor unless it is pedunculated; if so, make a curved incision on each side of its base. Usually small blood vessels at the base of the tumor will require ligation.
Key Takeaways
- Local anesthesia is crucial for pain management during surgical procedures.
- Removing the matrix of an ingrowing nail prevents recurrence.
- Sebaceous cysts should be dissected without emptying their contents to avoid recurrence.
Practical Tips
- Use a sharp bistoury to ensure clean cuts when removing the matrix.
- Apply sterile gauze and allow granulation for proper healing after surgery.
Warnings & Risks
- Failure to remove the entire matrix can lead to ingrowing toe-nail recurrence.
- Emptying cyst contents during removal increases risk of recurrence if not all walls are removed.
Modern Application
While modern medicine has advanced surgical techniques and pain management, understanding historical methods like those described here is still valuable. They provide a foundation for emergency situations where specialized equipment or medical professionals may be unavailable.
Frequently Asked Questions
Q: What is the critical step in treating an ingrowing toe-nail?
The key step is to remove the entire matrix of the nail, not just the part that is causing pain. This prevents recurrence of the condition.
Q: How should sebaceous cysts be removed?
Sebaceous cysts should be dissected out without emptying their contents first to avoid recurrence. If emptied, ensure all walls are completely removed.
Q: What is the role of local anesthesia in these procedures?
Local anesthesia is used to manage pain during surgical procedures such as removing ingrowing toe-nails and sebaceous cysts.