This raises many interesting questions.
Many different people do ingrown nail procedures. MD, DO, DPM, nurses, primary care, ER, etc. I wonder how similar each is in their procedure.
Do nail avulsions need to be done as often as they are? There are other ways to fix this issue other than removing a part of the nail.
Why do some people have such high recurrence rates? If you are having a procedure for the 12th time (I've heard this), then this is probably the wrong procedure. There are many different types of procedures, and a doctor that does only one all the time is doing a disservice to their patients.
Do nail avulsions need to be so gruesome? Again, there are many different ways to do the same procedure, and some people are more messy.
I guess the point is that everyone does them differently. You'll see that ingrown toenails can be extremely painful and debilitating, but this is one issue that can be fixed quickly and bring much relief to the patient.
I'm not sure exactly what point(s) you are trying to make, but I don't agree with the majority of your post. As a student, I'm not sure where you are coming from with your comments.
1) You ask if nail avulsions need to be performed as often or if there is a better way to treat the problem. Well, if a doctor is honest and ethical, he/she is performing an avulsion when a patient has pain, inflammation, infection, etc. The patient can be on antibiotics forever, and although that may reduce some of the infection, it will NEVER heal without removing the offending nail border that is penetrating the skin. So these procedures aren't being performed too often, they should be performed when indicated, just as ANY procedure. And if the nail is penetrating the skin, there is no other way to correct the problem. There ARE ways to help prevent the problem such as teaching the patient how to cut the nails properly, avoiding tight shoes, avoiding pedicures, etc.
2) You ask why there are such high recurrence rates??? If an ingrown nail is chronically recurrent, it should be permanently corrected. By FAR the most common procedures performed involve chemical erradication of the matrix after avulsion, using phenol or sodium hydroxide. These procedures are extremely simple, can be performed in under 5 minutues in the office and are extremely effective. "Cold steel" procedures are performed much less often and are usually a little more traumatic and painful post procedure, though are sometimes preferred or indicated.
3) You state that there are many ways to perform an avulsion and ask if they have to be so gruesome. Over my many years of practice I have performed or witnessed of thousands of these procedures, performed by many practitioners, and the vast majority were done in a VERY similar manner. There's not much to do....anesthetize the toe, free the nail from the nail bed back below the eponychium then remove the nail with a hemostat, etc. In reality there really AREN'T that many ways to
perform this simple and effective procedure.
4) Make sure you are not using the terms avulsion and a permanent correction of an ingrown nail in the same context. There is a large difference.
