Terminal Syme The Terminal Syme procedure is basically an amputation of the tip of the toe. I'd like to say this procedure is rarely done any longer for routine ingrown nails, but from time to time, I still see people who have had this done. There are very few indications for this procedure to be performed.
Simply put, chemical procedures attempt to permanently resolve an ingrown nail by chauterizing the nail root through the application of a strong chemical. Because the root of the nail is not actually removed, chemical procedures are not really matrixectomies, though they are often referred to as being so.
In theory, any chemical strong enough to chauterize the root of the nail without adversely affecting the patient could be used, but the most common chemical techniques are listed below.
The advantage of chemical procedures are that they are known for being relatively painless; there is typically no scalpel used in these procedures, so there is little scarring, and so they also tend to look very nice after they are completely healed; and chemical procedures don't denude the covering from the underlying bone, which diminishes the odds of a post-operative bone infection.
The downside to these procedures is that they create a minor chemical burn in the area, so they tend to drain. Soaking and bandage changes are usually prescribed.
The most common names you might hear?
Phenol The phenol procedure involves applying an acidic chemical known as phenol to the root of the nail. (See diagram to the right for an image of phenol's chemical structure.) This is probably the most common chemical procedure used today.
P&A The P&A procedure is short for "Phenol and Alcohol", because alcohol is commonly used at the end of the phenol procedure to wash away any remaining phenol. So a P& A is the same as a phenol procedure.
Sodium Hydroxide The second most common chemical method involves using the base known as Sodium Hydroxide. Some practitioners believe it creates less drainage than phenol procedures.
NaOH Those of you who have studied chemistry may recall that NaOH is the chemical abbreviation for sodium hydroxide, so the NaOH procedure is the same as the Sodium Hydroxide procedure.
In addition to sharp procedures and chemical procedures, other techniques exist to address ingrown nails. The two most common are listed below: