1. Ingrown toenail / paronychium.

2. Excising an ingrowing toenail. (Partial resection)
HEIFETZ PROCEDURE
Excising an ingrowing toenail.
(Partial resection)

3. 1. Ring block (without adrenaline). 2. Applying a tourniquet.
3. Incising through the nail and nailbed.
4. Removing a wedge of nail and granulomatous tissue.

4. 5. Lifting the nail segment. 6. Excising the germinal matrix.
7. The wedge of has now been removed.
8. Curettage to ensure there is no residual matrix.

5. 9. Application of a topical spray.
10. Suturing the angular portion of the wound.
11. Apply an adequate firm dressing.

6. Excising an ingrowing toenail. (Permanent removal)
ZADEK’S PROCEDURE
Excising an ingrowing toenail.
(Permanent removal)

7. 2. Incising the nail margin.
1. Applying a tourniquet after a local block.
2. Incising the nail margin.
3. Reflecting the flap proximally.
4. The nail lifted clear.

8. 6. The intact germinal matrix as removed.
5. Excision of the germinal matrix.
6. The intact germinal matrix as removed.
7. The clean nailbed.
8. Angular sutures.