## 4 Discussion  
Nail surgery has been identified as the tenth most commonly performed procedure by many healthcare professionals, including GPs, orthopedic surgeons, and podiatrists. Surgery for an ingrown nail mostly involves partial or complete removal of the nail plate and excision of the nail bed, often combined with ablation of the nail matrix to stop regrowth. Radical excision of the nail bed is associated with a higher risk of postoperative infection compared with other procedures involving ingrown nails [8; 9; 10]. [PERSON] et al. conducted a prospective observational study on patients with stage 2-3 ingrown nails who underwent partial onychectomy with silver nitrate chemical matricectomy in 2018-2019. The success rate of the procedure was 95.3%, with only 11 recurrences (4.7%) at follow-up. Postoperative infections were observed in four patients (1.7%). Side effects, such as pain and postoperative drainage, were negligible in most patients [11]. [PERSON] et al. reviewed five databases (MEDLINE, Embase, CINAHL, Web of Science, and CENTRAL) and two registries (Clinicaltrials.gov and ISRCTN) up until January 2022 for randomized trials evaluating the effect of surgical intervention(s) on ingrown toenails with at least 1-month follow-up. In these studies, no beneficial effect was observed between chemical or surgical versus conservative treatment (0.55 [0.19 to 1.61], \(p\) = 0.280; 0.72 [0.33 to 1.56], \(p\) = 0.410) and chemical or surgical versus other (e.g., CO\({}_{2}\) laser, electrocautery, and electrocoagulation) (1.61 [0.88 to 2.95], \(p\) = 0.120; 0.58 [0.25 to 1.37], \(p\) = 0.220). Central nail resection was the only procedure that significantly relieved symptoms (\(p\) = 0.001), but data were only available up to eight weeks after the procedure. Despite the large number of  
Figure 9: A 13-year-old boy. The 4b stage of ingrowth in both toes. Duration of the disease: 1 year. Cause of ingrowth: hyperhidrosis, sports shoes, and improper trimming. Two buckles were applied to the left big toe—effect after 2 months of treatment (**a**); one buckle was applied to the right big toe—effect after 1 month (**b**). Source: own archives. publications, the quality of the studies was poor, the conclusions from existing studies are limited, and there is still no good quality evidence to guide practice [3]. A study by [PERSON] et al. showed that after wedge resections and the Vandenbos procedure, a total of 78 complications and recurrences occurred in the wedge resection group (21%), while a total of 32 complications and recurrences occurred in the Vandenbos group (14%; \(p=0.0949\)). A total of 46 first recurrences of IGTN occurred after the first surgery [12]. An alternative to surgery is orthonyxia, a pediatric method of correcting the shape of the nails using buckles. It is a non-invasive, bloodless, and painless method that aims to reduce the pressure of the lateral edges of the nail on the soft tissues in the area of the lateral wall and to quickly eliminate pain, as well as to change the growth trajectory and restore the normal plane of the nail plate. Depending on the stage of the disease and factors such as the thickness, degree of vaulting, or transverse curvature of the plate, stainless steel (surgical) metal buckles or plastic buckles are used. Metal buckles take the form of appropriately shaped wires, which are formed individually for each application. Their mechanism of action is similar to that of orthodontic braces. The buckle does not interfere with the patient's activities of daily living; it grows together with the nail plate while correcting an ingrown or curved nail (unguis convolutus) [5; 6; 13]. Although the published data describing how ingrown nail pathology is treated conservatively in pediatric practice are rare, the literature data suggest that most previous studies are retrospective small-scale case series with short follow-up times. Further research into these relationships is recommended to enable evidence-based practice [14]. [PERSON] et al.