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Zadek procedure

The Zadek procedure is one of the more radical methods of curing an ingrown toe nail, but will result in a permanent cure of the problem in most cases, although there may be a recurrence in about 10% of patients. It is only performed if the nail is significantly ingrown, or previous procedures have been unsuccessful. The aim of the operation is to permanently narrow the nail by one quarter to one third of its width.

After cleaning the toe with an antiseptic solution, the patient will be given an anaesthetic injection into either side of the base of the toe. There is then a five to ten minute wait for the anaesthetic to be effective. Sometimes a third injection is given into the end of the toe after this time.

A tourniquet (often a broad rubber band) is then placed around the base of the toe, it is again cleaned with antiseptic, and draped with a sterile dressing. The operation is then performed. The patient may feel pulling and tugging, but no pain should be felt. If pain is experienced, tell the doctor, and more anaesthetic will be given.

During the procedure a cut is made from the flesh behind the base of the nail, through the entire length of the nail. A second cut is made around the outside edge of the nail to curve around and meet the first cut at both ends.

These cuts are deepened to meet in the flesh beneath the nail, and a wedge of nail and flesh is removed. Part of the nail bed behind the base of the nail is also removed in the wedge.

In most cases, the defect in the nail is then sewn up with stitches through both the flesh and the nail, the tourniquet is removed, and a firm dressing is applied. It is necessary to return to have a lighter dressing applied after one day, and to have the stitches removed after ten days.