Vertical half-mattress suture combined with Winograd procedure for ingrown toenails: a retrospective comparative observational study

Ingrown toenail is a common traumatic and infectious foot disorder, characterized by pain, inflammation, and granulation tissue formation secondary to nail plate embedding into the periungual soft tissue. The Winograd procedure is a widely used surgical intervention; however, conventional suture techniques are associated with high recurrence rates and suboptimal postoperative cosmetic outcomes. This study aimed to evaluate the clinical efficacy and safety of vertical half‑mattress suture combined with the Winograd procedure for ingrown toenails, to provide evidence for optimized surgical management. This retrospective comparative observational study enrolled 80 patients (106 great toes) with Heifetz stage II–III ingrown toenails who underwent surgery at the Orthopedic Center between July 2022 and January 2024. Patients were divided into two groups based on suture technique: the observation group (n = 40, 54 great toes) received the Winograd procedure plus vertical half-mattress suture (classic type, n = 20, 27 great toes; modified type, n = 20, 27 great toes), and the control group (n = 40, 52 great toes) received the Winograd procedure plus conventional interrupted suture. Primary and secondary outcomes included visual analogue scale (VAS) pain scores, wound healing time, time to return to shoe wear, 2-year recurrence rate, cosmetic satisfaction, and complication rate. All patients completed 2 years of follow-up. To address within-patient correlation caused by bilateral affected toes, a patient-level sensitivity analysis was performed on all 80 patients, with 40 patients per group, to re-analyze all key outcomes and assess result robustness. Baseline characteristics were comparable between groups (all P > 0.05). At 2-year follow-up, the observation group demonstrated superior outcomes across key endpoints. Recurrence rates were lower in both toe-level (5.6% vs. 13.5%, P = 0.042) and patient-level analyses (5.0% vs. 12.5%, P = 0.039). Overall complication incidence was also reduced at both levels: toe-level (1.9% vs. 15.4%, P = 0.025) and patient-level (2.5% vs. 20.0%, P = 0.014), with fewer Clavien–Dindo Grade I complications (2.5% vs. 15.0%, P = 0.047) and no Grade II infections in the observation group. Patients in the observation group returned to wearing shoes earlier [11.20 ± 2.15 days vs. 13.56 ± 3.08 days, P = 0.001], while wound healing times did not differ significantly (11.1 ± 1.2 vs. 11.3 ± 1.7 days, P = 0.512). Cosmetic satisfaction was higher in the observation group (92.6% vs. 78.8%, P = 0.028). Although VAS scores were lower in the observation group at 2 years [1.4 (IQR 1.3–1.5) vs. 1.6 (IQR 1.4–1.8)], the difference did not reach the minimal clinically important difference for foot pain. Subgroup analysis by suture technique revealed no significant differences. Patient-level sensitivity analysis confirmed these findings, with advantages in recurrence (P = 0.039), complications (P = 0.014), and time to return to shoes (P = 0.000). Vertical half-mattress suture as an adjunct to the Winograd procedure was associated with reduced recurrence rates and complications, shorter time to resume normal footwear, and improved cosmetic satisfaction, with no clinically meaningful difference in pain relief between the groups. These findings suggest that this technique is safe, effective, and worthy of further prospective validation.