Zadek’s procedure is the removal of the whole toenail and then cutting away the nail matrix in cases of ingrown toenails.
Indications for a Zadek’s procedure;
Chronic/recurrent ingrown toenail
Severe infection or granulation tissue
Failed prior conservative or partial procedures
Patient preference for permanent solution
Step-by-Step of Procedure:
Pre-op Preparation:
Consent (permanent nail loss, potential complications)
Clean and prep toe under sterile conditions
Apply digital tourniquet (rubber band or Penrose drain)
Anesthesia:
Local anesthesia: digital block (usually lidocaine 1% or bupivacaine 0.5%)
Nail Removal:
Full avulsion of the nail plate (carefully lift and remove nail)
Nail Matrix Excision:
Carefully dissect and excise the entire nail matrix (both germinal and sterile matrix).
This can be done via:
– Sharp dissection with scalpel and scissors
– Curettage (to scrape matrix cells)
Ensure all matrix tissue is removed to avoid recurrence.
Hemostasis:
Release tourniquet once bleeding controlled.
Occasionally cautery is used for bleeding points.
Closure:
Usually left open to heal by secondary intention
Occasionally sutured if needed
Dressing:
Non-adherent dressing with antibiotic ointment
Pressure dressing to minimize bleeding
Post-op Care:
Elevation of foot for 24-48 hours
Daily dressing changes
Antibiotics if signs of infection
Full healing: ~2-4 weeks
Possible Complications of a Zadek’s procedure:
Infection
Delayed wound healing
Nail spicule regrowth (if matrix not fully excised)
Sensory changes or numbness
Cosmetic dissatisfaction (permanent nail loss)