WOFAPS 2025 8th World Congress of Pediatric Surgery

Shermeen More, Leel Nellihela, Manasvi Upadhyaya

Evelina London Children's Hospital, London, United Kingdom

Aim
Ingrowing toenails (IGTN) in children are a common yet challenging condition requiring surgical intervention. This study evaluates the outcomes of surgical management, highlighting complications, recurrence rates, and the role of post-operative antibiotics.

Method
Retrospective review of medical records of patients, under 16 years, referred to a tertiary paediatric surgical hospital with IGTN, between 2016 and 2024. Wedge excisions (WE) or avulsions were performed as day-case surgery. Chi-square test was used to determine the efficacy of post-operative antibiotic in preventing infection, with p-value of < 0.05 considered as significant.

Results

A total of 354 patients underwent 868 procedures. Mean age was 13 years (range 7 months- 16 years).

Bilateral procedures were performed in 151/354. 45/354 underwent procedure under local anaesthesia, rest needed general anaesthesia. The lateral aspect was more affected than the medial in both toes: left (241;154), right (220;163).

140 patients had a follow up. 67/140 were asymptomatic. 27/140 reported post-operative wound infections, requiring treatment with antibiotics. 18 out of these 27 were previously discharged without any post-operative antibiotics. Chi-square test demonstrated no significant association between the use of post-operative antibiotics and development of infection (p-value 0.48). 1/140 was treated for bleeding.

84 recurrences were documented in 45/354 patients. 71/84 recurrences were treated surgically.

48 new occurrences were reported in 34 patients. 45/48 were treated surgically.

Conclusion

Procedures for IGTN had high complication rates (52%). To improve patient-reported outcomes, a one-stop shop approach with surgical follow-ups at 7 days (infection) and 3 months (recurrences/ new occurrences) could be considered. This may reduce treatment delays by eliminating the need for GP visits and referrals.

Furthermore, it is worth rationalizing the use of post-operative antibiotics, as there was no significant link between infection and the use of antibiotics. These findings can inform standardized paediatric surgical pathways for IGTN management