Outcome of Partial Nail Plate and Matrix Removal (Winograd Technique) for Ingrown Toe Nail

INTRODUCTION: Ingrown toe nails are one of the common and painful condition of foot. The most common presentation is distal lateral ingrowing. When the conservative treatment fails, problem is recurrent or if the lesion is more severe<surgical treatment is advised. Surgical treatment consists of partial or complete nail excision in combination or without partial matricectomy. This study highlights the results of surgical intervention with Winograd technique. MATERIAL AND METHODS: The study was conducted at Liaquat university hospital and a private practice setup between January 2010 and July 2011. The inclusion criteria was adult patients of either sex with ingrown toe nail in stage two and three involving big toe. A total of 70 patients were enrolled in the study. Sixty five patients with 65 toes were finally registered for follow up. Winograd surgical technique was used for excising lateral 20% to 25% of the ingrown nail with matrix removal. Primary outcome measures were<well healed wound<pain free toe<and no recurrence. Secondary outcome measures were post operative infection and recurrence within one year after surgery. RESULTS: Thirty (46.15%) patients were male and 35(53.85%) female. Their mean age was 27.30 years (range 20 to 45 years). The mean follow up period was 9.46 Months. Twenty five patients (38.46%) were in stage II and 40(61.54%) were in stage III. Fifty eight patients (89.23%) recovered uneventfully with no postoperative complications. There mean recovery time was<13.62 days. Early postoperative complications were seen in seven (10.76%) patients. Two had swelling and 5 patients (7.69%) develop postoperative infection. These seven patients with infection and swelling recovered in the mean time of 20.71days<whereas all recovered in the mean time of 14.38 days. Recurrence was seen in 4.61% within a mean period of 5 months. With chi square test only 3 cases had recurrence and 62 behave satisfactory with p value of P< 0.0001. All the Ten patients (15.38%) who develop complications belong to Heifetz stage III at the time of surgery. Sixty two out of 65 patients (92.30%) were satisfied with the treatment. CONCLUSION: The Winograd technique of partial nail plate and matrix removal is inexpensive, effective<safe and easy to perform. The procedure has low recurrence rate. The postoperative complications are more common in patients presenting with Heifetz stage III disease.