IGTN

1. Position the patient supine and prep to above ankle level. Square drape.
2. Infiltrate as ring block without using adrenaline
3. Apply tourniquet (rubber band) at base of great toe after exsanguinating with pressure.
4. Use straight Iris scissors to lift edge of nail on the side of paronychia up to the nail plate and then cut the nail up to this mark.
5. Make an incision with a no.15 blade along lateral border of nail up to and incorporating the apex/corner of nail plate in a V.
6. Complete the excision by scalpel to excise all nail/nail bed tissue.
7. Can supplement excision by using Phenol or silver nitrate to cauterize the apex of the incision to obliterate any remaining nail bed tissue.
8. Use a steristrip to bring the created flap of lateral skin inwards and close the defect (can also suture to nail).
9. Apply dressings (tulle gras, gauze, crepe) leaving a window at the tip and release tourniquet.