The Effect of Removal of Granulation Tissue on Ingrown Toenails Associated with Granulation Tissue

Background: Ingrown toenail is a common disorder that occurs most frequently in the big toe and gives affected patient great discomfort and pain. Granulation tissue of nail wall results from ulceration and inflammation by excessive contact between the nail edge and the soft tissues of the nail wall and induces aggravation of the ingrown toenail. Objective: To decide whether removal of granulation tissue by electrocautery or not with lateral nail avulsion and matricectomy is the effective treatment in ingrown toenails with granulation tissue. Methods: Randomized clinical trial with 12 month follow-up evaluations performed by observers. 33 patients with a total of 37 ingrown toenails were treated partial nail avulsion followed by mastricectomy and removal of granulation (granulation removal group), and 36 patients with 40 ingrown toenails were treated without removal of granulation tissue (control group). The determinations of effectiveness were based on the recurrence rate, duration of post-operative pain, wound healing time and post-operative infection. Results: There was no significant difference in recurrence rates between the granulation removal group (15%) and control group (22%). There was a significant difference in the wound healing time between the granulation removal group (13.8 days) and control group (17.6 days). But there were no significant differences for the duration of post-operative pain and post-operative infection between the two groups. There were correlations between recurrence and duration of post-operative pain, wound healing time and post-operative infection. Conclusion: Procedures with granulation removal are an effective treatment for the treatment of ingrown nails, with the tendency of shorter times to reach complete recovery. But the effect of granulation removal has limited effect on reducing recurrence. (Korean J Dermatol 2008;46(4):453∼458)