Minimal Matricectomy Combined with Lateral Longitudinal Excision Versus Total Nail Avulsion for Ingrown Toenail: A Two-Center Retrospective Cohort Study with Propensity Score Analysis

Background and Objectives: Ingrown toenail frequently causes pain and infection and may recur following surgical treatment. This study compared a nail-preserving strategy, minimal matricectomy combined with lateral longitudinal excision, against total nail avulsion for recurrence and clinical outcomes, using propensity-score analysis to address non-randomized treatment allocation. Materials and Methods: In this two-center retrospective cohort study, 412 patients treated between January 2020 and December 2024 were classified according to the surgical procedure received: minimal matricectomy with lateral longitudinal excision (n = 233) or total nail avulsion (n = 179). The primary endpoint was recurrence; secondary outcomes included postoperative pain, healing time, infection, reintervention, return to activity, and patient satisfaction. Inverse probability of treatment weighting (IPTW) was used as a sensitivity analysis, and recurrence-free survival was assessed using the Kaplan–Meier method with the log-rank test. Results: Over a mean follow-up of 18 months, recurrence occurred in 1.7% (n = 4) of the minimal matricectomy group versus 12.3% (n = 22) of the avulsion group (p < 0.001; crude OR 8.0, 95% CI 2.7–23.7). After IPTW adjustment, the association remained consistent (adjusted OR 7.4, 95% CI 2.6–21.3; standardized mean differences <0.10 for all covariates). Kaplan–Meier analysis confirmed significantly higher recurrence-free survival with minimal matricectomy (log-rank p < 0.001). Reintervention (1.3% vs. 9.5%) and return to normal activity (5 vs. 9 days) also favored minimal matricectomy, with lower pain scores, shorter healing, fewer infections, and higher satisfaction. Conclusions: Minimal matricectomy combined with lateral longitudinal excision was associated with lower recurrence and improved clinical outcomes compared with total nail avulsion. This association remained statistically significant after propensity score adjustment for measured baseline covariates. Prospective randomized studies are warranted to confirm these findings.