Chronic, symptomatic stage III ingrown toenail treated with total germinal matrix excision (Quenu). A, Skin incisions. B, Total nail plate is removed. C, Germinal matrix protruding from beneath eponychium can be differentiated from dormant matrix, which is abnormal. D, All germinal matrix must be removed. E, Eponychium is replaced adjacent to dormant matrix, which remains. In this instance, it has been damaged by the mycotic process.