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My own top tips for treating ingrowing toenail

I have done toenails for 20 years, initially much to Dr Nigel Stollery's formula (10 Top Tips, March 3). Fifteen years ago I changed after basic thoughts and observations. From the last audit I now get more than 94 per cent success, so here are a few thoughts.

This is a procedure done largely on fit, healthy people. So I let the bleeding settle naturally ­ our bodies are programmed to do it. The procedure takes seven to 10 minutes maximum, this is plenty of time for the bleeding to stop.

Then when the patient stands again the bleeding will not restart. Using a tourniquet damages more tissue and stops the natural control of bleeding, even worse when you take the tourniquet off you get a rush of blood to soak bandages as the patient stands. Never use a tourniquet.

You can then use a small plaster and, with good advice, there is no need to follow up the patient routinely.

Bleeding comes mainly from the granulation tissue ­ leave this alone. Once the offending bit of nail is off it will naturally settle. Dab the bleeding ­ never wipe. When avulsing the nail do it away from the granulation tissue or you will cause more bleeding.

Cutting down the nail, do get through the last bit fully ­ leave it behind at your peril. This needs the best scissors you can find (always the ones to go missing). Always use phenol and double-ended cotton wool buds, the dry end to get all blood out and open a path for the phenol bud.

Finally, many victims will be teenagers. This is a great moment to establish some street cred so do engage in exploring the latest music, gigs and gossip ­ it can be surprising what people will tell you as you remove toenails.

The information gleaned can then be launched on the next teenager ­ even better you can tell your own teenagers what is happening, a jaw-dropping moment to savour!

Dr John Sampson

Poringland

Norfolk

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