A Comparative Evaluation of Surgical Approaches for Ingrown Toenail: Outcomes of Winograd Variants, Vandenbos, and Zadik Procedures in a Retrospective Cohort.

Abstract

Onychocryptosis can be treated using several surgical techniques, but comparative evidence remains limited and is susceptible to differences in disease severity and treatment selection. To compare recurrence and postoperative complication rates among six surgical approaches for ingrown toenail. Retrospective cohort study. A total of 798 patients (966 treated nails) who underwent surgery for ingrown toenail between June 2022 and June 2025 were included. Patients were categorized into six groups according to the surgical technique performed, including Winograd variants, the Vandenbos procedure, and the Zadik procedure. Outcomes were analyzed at the patient level; bilateral cases were recorded as bilateral but were not duplicated. Recurrence was defined as symptoms and/or nail-edge regrowth requiring further surgical intervention during postoperative weeks 8-12. Group comparisons used exact tests, and exploratory Firth-penalized logistic regression was performed for recurrence. Recurrence occurred in 31 patients (3.9%). Recurrence rates ranged from 2.1% to 8.8% across groups, without a significant overall difference (exact p = 0.276). Twenty-three patients (2.9%) experienced at least one postoperative complication. Complication rates differed significantly among groups (exact p = 0.009); after Bonferroni correction, only the comparison between the Vandenbos procedure (Group 5) and the Zadik procedure (Group 6) remained significant, with a lower complication rate in the Vandenbos group (adjusted p = 0.049). In exploratory adjusted analysis, Heifetz stage III was associated with recurrence (OR, 5.04; 95% CI, 1.84-13.79). No significant overall difference in early recurrence was observed among the evaluated surgical techniques. Disease severity was associated with recurrence, and complication profiles differed between groups. These findings should be interpreted cautiously because of retrospective treatment allocation and limited recurrence events.