DOI: 10.47582/jompac.2011440 ISSN: 2717-7505

Classic versus modified Winograd technique for ingrown toenail: a retrospective comparison of primary suture and healing by secondary intention

Sangar Abdullah, Güney Özkaya, Mahmut Zenciroğlu, Mustafa Kağan Başdoğan
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Aims: Partial matricectomy by the Winograd technique is a common surgical treatment for ingrown toenail, and several modifications have been described. This study compared the classic Winograd technique with primary suture against a modified technique in which the wound is left open to heal by secondary intention.Methods: The records of patients who underwent surgery for Heifetz stage 2 or 3 ingrown toenail of the great toe between February 2021 and November 2023 at a tertiary training and research hospital were reviewed retrospectively, with follow-up completed in November 2024. Patients with diabetes mellitus, previous surgery for recurrent disease, or total nail excision were excluded. A single index nail was analysed per patient. The primary outcome was time to return to work or usual daily activities; secondary outcomes were recurrence, surgical site infection, and patient satisfaction. Recurrence was analysed using Kaplan-Meier and Cox proportional hazards methods. Results: Of 171 patients screened, 131 were analysed (66 classic Winograd, 65 modified). Median follow-up was 24.8 months. Return to work or usual daily activities was one day earlier after the classic technique (median 9 versus 10 days; p=0.011; Hodges–Lehmann median difference 1 day, 95% CI 0 to 2). Recurrence occurred in 12.1% and 10.8% respectively, with no difference in recurrence-free survival (log-rank p=0.95; HR 0.97, 95% CI 0.35–2.67). Surgical site infection (9.1% versus 12.3%, p=0.585) and satisfaction (92.4% versus 89.2% satisfied or very satisfied, p=0.561) did not differ significantly.Conclusion: No statistically significant differences in recurrence, infection, or satisfaction were observed between the techniques, with a clinically small difference in return to work.

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