Surgical pearl: a simple splinting technique for severe (stage III) ingrown nails

An ingrown toenail is a painful disorder of the lateral nail fold associated with inflammation, infection, and granuloma formation. Various conservative modalities have been described to reduce the pressure of an ingrown nail on its gutter. The invasive option is preferred for severe ingrown nails (grade III). Here an innovative, less invasive technique is described to treat severe grades of ingrown nails with the use of mosquito artery forceps and cyanoacrylate glue. The glue on curing becomes a hard cast that blunts and insulates the nail from its gutter, protecting the gutter from nail injury. The glue is hygroscopic and antiinfective, making the gutter dry, healthy, and maceration-free. The ingrown nail becomes asymptomatic within half an hour of splinting, and the granuloma heals within 3 to 6 weeks. Thus chemical splinting with cyanoacrylate glue is a novel and fast conservative technique for treating severe grades of ingrown toenails in outpatient care units.