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very bloody.   While a granuloma excision may performed as an isolated procedure, it is frequently performed along with a permanent nail procedure.  

Skin Plasties  Skin plasties are techniques that primarily address an abnormal component of skin that may be the cause of the problem.  For example, a portion of skin may be excessively large and the nail may continually grow into the skin.  Again, this may be performed as an isolated procedure or in conjunction with a permanent nail procedure.   

Permanent Nail Procedures

There are three families of procedures that permanently address nail conditions--"sharp" procedures, chemical procedures, and miscellaneous procedures.   

procedures are known by that name because they all have in common the use of a scalpel to excise a portion of the nail root.  Because the nail root is being cut out, or "excised", this family of procedures is properly known as known as matrixectomy procedures, with the suffix "-ectomy" meaning "excision".  A matrixectomy may either be a partial matrixectomy, when only a portion of the nail root is removed, or a total or complete matrixectomy, when the entire nail root is removed.  

Compared to chemical procedures, sharp procedures have the advantage of looking better immediately after the procedure, and they typically have less drainage.  

While sharp procedures are still performed frequently by other medical professionals, it's probably safe to say that In the podiatric profession they are performed much more infrequently today than in years past because of their down side.   First, there is cutting involved, so they may create more scar tissue than other types of procedures, they may have a more noticeable post-operative appearance, they may hurt more and they physically remove the nail root from the bone, potentially increasing the odds of a bone infection.  

Suppan  This procedure involves freeing the skin behind the nail and removing the nail, then peeling away the root of the nail.  

Zadik Procedure  This procedure involves an incision that is angled at about 45 degrees from the nail border, and excising just the nail root.    

Frost Procedure  One of the older "sharp" procedures, the Frost involves making an "L"-shaped incision behind the nail plate, peeling back the soft tissues to expose and excise the nail root and any abnormal soft tissue associated with it.  

Winograd  The Winograd procedure involves a "D"-shaped excision of the nail root and overlying soft tissues.  Not so aggressive as the Kaplan procedure, the Winograd may be a good choice when sharp procedures are considered.  

Kaplan  The Kaplan procedure may be the most well documented nail procedure in the literature.  It involves an "H"-shaped incision and requires the excision of both the nail root and the nail bed (the soft tissue upon which then nail rests).   This procedure may still be indicated in cases where the bone underlying the nail is involved, but this procedure is more aggressive then necessary for the vast majority of ingrown nails.   

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