Pulpar-Far Resection: A Novel Surgical Technique Compared to the Winograd Method in the Treatment of Ingrown Toenails

Abstract

Aim: To compare the clinical and cosmetic outcomes of the novel Pulpar-Far resection with the conventional Winograd technique in the surgical treatment of stage 2 and 3 onychocryptosis. Materials and Methods: This retrospective cohort study included 108 patients (mean age, 27.57 years) who underwent surgical treatment for stage 2 or 3 onychocryptosis between November 2021 and November 2023. Patients were treated with either the Pulpar- Far resection (n=54) or the Winograd procedure (n=54). Clinical outcomes included postoperative pain assessed using the Visual Analog Scale (VAS), recovery time, and time to return to daily activities. Recurrence rates and patient-reported cosmetic satisfaction were also evaluated. All patients had a minimum follow-up of 12 months, with a mean follow-up duration of 20.17±7.88 months. Results: Patients who underwent the Pulpar-Far resection showed significantly quicker recovery (12.72±1.47 vs. 17.61±2.39 days; p <0.001) and an earlier return to activities (3.80±1.23 vs. 7.46±2.27 days; p <0.001) compared to those who had the Winograd procedure. One-week postoperative VAS pain scores were notably lower in the Pulpar-Far group (3.20±0.96 vs. 5.35±1.23; p <0.001). Cosmetic satisfaction was also higher in the Pulpar-Far group (98.1% vs. 81.48%; p <0.001). Although recurrence rates were lower with Pulpar-Far resection (1.85% vs. 9.26%), this difference was not statistically significant (p=0.204). Conclusion: Pulpar-Far resection provides superior postoperative recovery, reduced pain, and improved cosmetic satisfaction compared with the Winograd technique in the treatment of advanced onychocryptosis. As a novel surgical approach, it represents a promising alternative, particularly for patients in whom aesthetic outcomes are a priority.

Keywords

• cosmetic satisfaction
• ingrown toenail
• minimally invasive procedure
• pulpar-far resection; recurrence; Winograd technique

References

1. 1. Heidelbaugh JJ, Lee H. Management of the ingrown toenail. Am Fam Physician. 2009;79(4):303–308. PMID:19235497.
2. 2. Exley V, Jones K, O’Carroll G, Watson J, Backhouse M. A systematic review and meta-analysis of randomised controlled trials on surgical treatments for ingrown toenails part I. recurrence and relief of symptoms. J Foot Ankle Res. 2023;16(1):35.
3. 3. Tatlican S, Eren C, Yamangokturk B, Eskioglu F, Bostanci S. Chemical matricectomy with 10% sodium hydroxide for the treatment of ingrown toenails in people with diabetes. Dermatol Surg. 2010;36(2):219–22.
4. 4. Haneke E. Surgical treatment of ingrown toenails. Dermatol Surg. 2011;37(9):1289–1298.
5. 5. Yılmaz A, Çenesizoğlu E. Partial matricectomy with cryotherapy in treatment of ingrown toenails. Acta Orthop Traumatol Turc. 2016;50(3):262–8.
6. 6. Bianchi C, Cazzaniga S, Tosti A. Chemical matricectomy with 10% sodium hydroxide for the treatment of ingrowing toenails: a prospective study. Dermatol Ther. 2020;33(6):e14005.
7. 7. Kim J, Lee S, Lee JS. A Minimally-Invasive, Simple, Rapid, and Effective Surgical Technique for the Treatment of Ingrown Toenails: A Reminder of the Original Winograd Procedure. Int J Environ Res Public Health. 2021;18(1):278.
8. 8. Kose O, Guler F, Gurcan S. Cosmetic results of wedge resection of nail matrix (Winograd technique) in the treatment of ingrown toenail. Foot Ankle Spec. 2012;5(4):241–244.

9. 9. Acar E. Winograd Method Versus Winograd Method With Electrocoagulation in the Treatment of Ingrown Toenails. J Foot Ankle Surg. 2017;56(3):474–477.
10. 10. Vandenbos K, Bowers W. Ingrown toenail: a method of treatment. US Armed Forces Med J. 1959;10:384–391. PMID:13638794.
11. 11. Hassan RE, Khan L, Shah SH. Surgical Strategies for Ingrown Toenails: A Comprehensive Review of Techniques, Outcomes, and Advancements. Cureus. 2024;16(1):e52501.
12. 12. Misirovs R, Misirova J, Misirovs V. A comparative study of chemical matricectomy with 88% phenol and 10% sodium hydroxide for the treatment of ingrown toenails. Medicina (Kaunas) . 2021;57(6):556.
13. 13. Moriue T, Yoneda K, Moriue J. Comparison of partial nail avulsion with phenol and sodium hydroxide for the treatment of ingrown toenails. Dermatol Surg. 2012;38(12):2011–2015.
14. 14. Persichetti P, Simone P, Li Vecchi G. Wedge excision of the nail fold in the treatment of ingrown toenail. Ann Plast Surg. 2004;52(6):617–620.
15. 15. Zuber TJ. Ingrown toenail removal. Am Fam Physician. 2002;65(12):2547–2552. PMID:[12086244].
16. 16. Winograd AM. Resection of the nail matrix and nail bed. Arch Derm Syphilol. 1929;19(3):351–356.
17. 17. Oliveira F, Izquierdo-Cases JO, Martínez-Nova A, ContrerasBarragán E, Munuera-Martínez PV. The Modified versus the Conventional Winograd Technique for the Treatment of Onychocryptosis: A Retrospective Study. Int J Environ Res Public Health. 2022;19(13):7818.
18. 18. Kocak S, Ozyalcin A. Modified Winograd technique versus partial resection with electrocoagulation for surgical management of ingrown toenails. J Orthop Surg Res. 2025;20(1):361.
19. 19. Shang X, Jin Y, Meng X, Zhu H, Sun X, Xue Y, et al. A novel modified Winograd surgical tricks and tips with a “bird flap” for the treatment of ingrown toenails. Foot Ankle Surg. 2023;29(4):361–366.
20. 20. Ma J, Chen J, Guo Y. A Standardized Six-Step Procedure for Ingrown Toenail Treatment: Improving Outcomes and Reproducibility. Dermatol Ther. 2020;33(6):e14005.
21. 21. Herruer JM, Prins JB, van Heerbeek N, Ingels KJ. Negative predictors for satisfaction in patients after facial cosmetic surgery: A systematic review. J Plast Reconstr Aesthet Surg. 2015;68(11):1526–1532.
22. 22. Jacobson WE, Gorney M, Janowsky D. Psychiatric evaluation of patients requesting cosmetic surgery. Plast Reconstr Surg. 1977;59(4):486–492