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Onychogryphosis is manifested by irregular thickening and curving of nails and the nailfold, resulting in ram horn appearance. No therapeutic modality that can normalize nails with onychogryphosis is yet available. Recommended therapies include palliative measures and various surgical interventions.The authors reviewed the outcomes of total matricectomy and V-Y advancement flap technique used for nail removal in patients with onychogryphosis at the big toe.The authors evaluated 14 patients with onychogryphosis, including 8 men and 6 women (15 big toes; 10 at the right foot and 5 at the left foot), who underwent total matricectomy and V-Y advancement flap technique. The general complaints included repeated nail removal, pain, cosmetic complaints, and difficulty in wearing shoe and footwear.Mean age of the patients was 42.4 years. Mean follow-up was 13.5 months. Clinical history revealed at least 2 previous nail removals. No complications were observed during the follow-up period. Mean time to return to daily activities was 4.5 weeks. Patient satisfaction was rated as very good in 9 patients and good in 5 patients.The surgical technique employed in patients with onychogryphosis is a safe treatment option with a high success rate.