Wound-closure strategy influences functional recovery and complication risk after Winograd surgery: a comparative cohort study

BACKGROUND: Although the modified Winograd procedure is an established surgical treatment for stage II-III ingrown toenails, the influence of wound-closure strategy on postoperative recovery and patient-reported outcomes remains insufficiently defined. This study evaluated whether adhesive skin-closure strips could improve early clinical outcomes compared with polypropylene sutures. METHODS: In this retrospective cohort study, 75 adult patients undergoing modified Winograd surgery were analyzed. Wound closure was performed using polypropylene sutures (n = 36) or adhesive strips (n = 39). Patient-reported functional and cosmetic satisfaction (five-point Likert scale), time to painless walking, return to daily activities, postoperative complications, and recurrence were assessed. Logistic regression quantified complication risk, and multivariable linear regression identified independent predictors of functional recovery. RESULTS: Baseline characteristics were comparable between groups. Adhesive strip closure was associated with significantly higher functional and cosmetic satisfaction (median 5 vs. 4, p < 0.001) and faster recovery, including earlier painless ambulation (6 vs. 9 days, p < 0.001) and faster return to daily activities (8 vs. 11 days, p < 0.001). Postoperative wound complications were substantially less frequent with adhesive strips (2.6 vs. 27.8%; χ² = 9.51, p = 0.002), and polypropylene suturing independently increased complication risk (OR 14.6, 95% CI 1.8-121.2). Adhesive strip closure remained an independent predictor of earlier painless walking (B = - 2.45, p < 0.001), whereas higher body mass index was associated with delayed recovery. CONCLUSION: Adhesive strip closure was associated with significantly improved early functional recovery and lower wound morbidity, without compromising recurrence outcomes after Winograd surgery. Optimization of wound-closure technique may represent a simple yet impactful strategy to improve patient-centred outcomes in ingrown toenail surgery. TRIAL REGISTRATION: This retrospective cohort study was not prospectively registered in a clinical trial registry.