Minimal Matricectomy Combined with Lateral Longitudinal Excision Versus Total Nail Avulsion for Ingrown Toenail: A Two-Center Retrospective Cohort Study with Propensity Score Analysis.
- 1Department of General Surgery, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Republic of Türkiye Ministry of Health, University of Health Sciences, Istanbul 34785, Türkiye.
Abstract
Background and Objectives: Ingrown toenail frequently causes pain and infection and may recur following surgical treatment. This study compared a nail-preserving strategy, minimal matricectomy combined with lateral longitudinal excision, against total nail avulsion for recurrence and clinical outcomes, using propensity-score analysis to address non-randomized treatment allocation. Materials and Methods: In this two-center retrospective cohort study, 412 patients treated between January 2020 and December 2024 were classified according to the surgical procedure received: minimal matricectomy with lateral longitudinal excision (n = 233) or total nail avulsion (n = 179). The primary endpoint was recurrence; secondary outcomes included postoperative pain, healing time, infection, reintervention, return to activity, and patient satisfaction. Inverse probability of treatment weighting (IPTW) was used as a sensitivity analysis, and recurrence-free survival was assessed using the Kaplan-Meier method with the log-rank test. Results: Over a mean follow-up of 18 months, recurrence occurred in 1.7% (n = 4) of the minimal matricectomy group versus 12.3% (n = 22) of the avulsion group (p < 0.001; crude OR 8.0, 95% CI 2.7-23.7). After IPTW adjustment, the association remained consistent (adjusted OR 7.4, 95% CI 2.6-21.3; standardized mean differences <0.10 for all covariates). Kaplan-Meier analysis confirmed significantly higher recurrence-free survival with minimal matricectomy (log-rank p < 0.001). Reintervention (1.3% vs. 9.5%) and return to normal activity (5 vs. 9 days) also favored minimal matricectomy, with lower pain scores, shorter healing, fewer infections, and higher satisfaction. Conclusions: Minimal matricectomy combined with lateral longitudinal excision was associated with lower recurrence and improved clinical outcomes compared with total nail avulsion. This association remained statistically significant after propensity score adjustment for measured baseline covariates. Prospective randomized studies are warranted to confirm these findings.
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BibTeX
@article{topcu2026minimal,
title = {{Minimal Matricectomy Combined with Lateral Longitudinal Excision Versus Total Nail Avulsion for Ingrown Toenail: A Two-Center Retrospective Cohort Study with Propensity Score Analysis.}},
author = {Ahmet Topcu and İsmail Ege Subaşı and Furkan Saydın},
journal = {Medicina (Kaunas, Lithuania)},
year = {2026},
month = oct,
doi = {10.3390/medicina62101986},
url = {https://europepmc.org/article/MED/42942517},
note = {CC BY},
}
RIS
TY - JOUR
TI - Minimal Matricectomy Combined with Lateral Longitudinal Excision Versus Total Nail Avulsion for Ingrown Toenail: A Two-Center Retrospective Cohort Study with Propensity Score Analysis.
AU - Ahmet Topcu
AU - İsmail Ege Subaşı
AU - Furkan Saydın
PY - 2026
DA - 2026/10/14
JO - Medicina (Kaunas, Lithuania)
DO - 10.3390/medicina62101986
UR - https://europepmc.org/article/MED/42942517
AB - Background and Objectives: Ingrown toenail frequently causes pain and infection and may recur following surgical treatment. This study compared a nail-preserving strategy, minimal matricectomy combined with lateral longitudinal excision, against total nail avulsion for recurrence and clinical outcomes, using propensity-score analysis to address non-randomized treatment allocation. Materials and Methods: In this two-center retrospective cohort study, 412 patients treated between January 2020 and December 2024 were classified according to the surgical procedure received: minimal matricectomy with lateral longitudinal excision (n = 233) or total nail avulsion (n = 179). The primary endpoint was recurrence; secondary outcomes included postoperative pain, healing time, infection, reintervention, return to activity, and patient satisfaction. Inverse probability of treatment weighting (IPTW) was used as a sensitivity analysis, and recurrence-free survival was assessed using the Kaplan-Meier method with the log-rank test. Results: Over a mean follow-up of 18 months, recurrence occurred in 1.7% (n = 4) of the minimal matricectomy group versus 12.3% (n = 22) of the avulsion group (p < 0.001; crude OR 8.0, 95% CI 2.7-23.7). After IPTW adjustment, the association remained consistent (adjusted OR 7.4, 95% CI 2.6-21.3; standardized mean differences <0.10 for all covariates). Kaplan-Meier analysis confirmed significantly higher recurrence-free survival with minimal matricectomy (log-rank p < 0.001). Reintervention (1.3% vs. 9.5%) and return to normal activity (5 vs. 9 days) also favored minimal matricectomy, with lower pain scores, shorter healing, fewer infections, and higher satisfaction. Conclusions: Minimal matricectomy combined with lateral longitudinal excision was associated with lower recurrence and improved clinical outcomes compared with total nail avulsion. This association remained statistically significant after propensity score adjustment for measured baseline covariates. Prospective randomized studies are warranted to confirm these findings.
SN - 1010-660X
SN - 1648-9144
ER -