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Ingrown toenail removal
Abstract
Ingrown toenail is a common problem resulting from various etiologies including improperly trimmed nails, hyperhidrosis, and poorly fitting shoes. Patients commonly present with pain in the affected nail but with progression, drainage, infection, and difficulty walking occur. Excision of the lateral nail plate combined with lateral matricectomy is thought to provide the best chance for eradication. The lateral aspect of the nail plate is removed with preservation of the remaining healthy nail plate. Electrocautery ablation is then used to destroy the exposed nail-forming matrix, creating a new lateral nail fold. Complications of the procedure include regrowth of a nail spicule secondary to incomplete matricectomy and postoperative nail bed infection. When performed correctly, the procedure produces the greatest success in the treatment of ingrown nails. Basic soft tissue surgery and electrosurgery experience are prerequisites for learning the technique.
... Die Erwartungshaltung des Patienten gegenüber dem Arzt ist oft hoch, es handelt sich schließlich "nur" um einen eingewachsenen Zehennagel. Von ärztlicher Seite ist hier jedoch äußerste Vorsicht geboten, nachdem konservative und operative Maßnahmen nicht selten von Misserfolg geprägt sind, insbesondere, wenn diese aufgrund der vermeintlichen Einfachheit leichtfertig von unerfahrenen Behandlern durchgeführt werden [1]. ...
... Besonders ist auf ein spitzes laterales Nagelspikulum zu achten. InderLiteratur werden in diesem Fall zwei verschiedene Vorgehen beschrieben [1,11,18]. Einige Autoren empfehlen die alleinige Glättung des Nagelspikulums, durch Entfernung eines Nagelkeils (. Abb. ...
... Für die alleinige Entfernung des Granulationsgewebes und die anschließende Glättung des lateralen Nagelspikulums sind Rezidivraten bis zu 30-70 % beschrieben [1,32]. Da hier die sorgfältige Entfernung des lateralen Matrixhorn und der Nagelmatrix ausbleibt, kann die Nagelplatte weiter entlang des Nagelwalls wachsen und zur ständigen Irritation führen [33]. ...
Zusammenfassung
Der Unguis incarnatus ist ein häufiges Krankheitsbild, mit dem sich Patienten in der Hausarztpraxis, der dermatologischen Klinik oder der chirurgischen Notaufnahme vorstellen. Häufig führt die inkonsequente konservative Therapie oder die falsch-indizierte operative Intervention zu langwierigen und komplikationsreichen Verläufen, inklusive Rezidiven. Die Patienten sollten über die Komplexität des Nagelorgans aufgeklärt werden, um der Banalisierung der Erkrankung vorzubeugen, und eine entsprechende Compliance in der Therapie zu erreichen. In diesem Manuskript wird die sachgerechte Versorgung des Unguis incarnatus im Sinne eines praktischen Behandlungsalgorithmus dargestellt. Die konsequente konservative Therapie ist bei akutem Unguis incarnatus mit milder Ausprägung die Therapie der ersten Wahl mit guten Behandlungsergebnissen. Nagelerhaltende operative Eingriffe kommen bei moderaten/schweren akuten Formen zum Einsatz. Der chronische Unguis incarnatus , ohne floride Infektion, stellt eine elektive Operationsindikation dar. Sowohl bei den nagelerhaltenden Eingriffen als auch bei erweiterten operativen Maßnahmen ist eine chirurgische Operationsaufklärung obligat.
... Distal lateral tırnak batması diğer tırnaklarda da görülebilmekle birlikte en sık ayak başparmaklarında görülmektedir (1)(2)(3)(4). Hastalık tüm ırklarda, her iki cinste ve her yaşta görülebilmekle birlikte çocukluklarda, genç erişkinlerde ve ileri yaş kadınlarda daha sık görülmektedir (3,4). ...
... Tırnak batması tedavisi batmanın evresine göre planlanmalıdır (1)(2)(3). Tedaviyi yapan profesyonelin uzmanlık alanının (dermatolog, genel cerrahi uzmanı, ortopedist, podiatrist vb.) da tedavi seçiminde bir diğer önemli faktör olduğu belirtilmiştir (2). Genel olarak evre 1 ve 2a olarak evrelenmiş olan tırnak batmalarında invaziv olmayan konservatif yöntemler yeterli olmaktayken, daha ileri evrelerde cerrahi tedavi yöntemlerine ihtiyaç duyulmakta ve daha başarılı sonuçlar elde edilmektedir (3). ...
... Lateral matriks boynuzunun fenol ile koterizasyonu en sık kullanılan yöntem olarak karşımıza çıkmaktadır (1)(2)(3)(4). Fenol koagülatif, dezenfektan ve analjezik özellikleri nedeniyle operasyon sonrası kanamayı, enfeksiyonu ve ağrıyı azaltmaktadır (30). Tırnak parsiyel olarak çekildikten sonra ucunda pamuk bulunan bir aplikatör ile fenol tırnak matriksini koterize etmek amacıyla uygulanır (30). ...
Ingrown toenail is a public health problem widely seen in all age groups. If ingrown toenails are not treated properly, permanent nail and toe deformities may occur. Staging of ingrown toenails is made according to presence of erythema, edema, pain, drainage, infection, granulation tissue and lateral nail wall hypertrophy. Treatment selection is made according to clinical stage. Expectations from therapeutic procedures can be listed as complete relief of symptoms, absence of recurrence, decreased post-operational pain, drainage and infection risk, minimization of healing time, cosmetically proper outcomes and patient satisfaction. General precautions are wider shoe wearing, proper nail trimming, and warm foot baths. Widely performed non-invasive treatments can be specified as taping, insertion of cotton wisps and plastic tubes, and application of nail braces. Surgical treatments are partial and total nail avulsion, procedures for the lateral nail fold, surgical and chemical matricectomies and combinations of them. Generally surgical methods are more effective than non-invasive ones. Most effective and safe procedures are the surgical and chemical matricectomies targeting nail matrix. Ingrown toenails can be successfully treated by dermatologists.
... [4,5] The available techniques for treatment of stages 2 and 3 ingrown nails are total removal of the nail, total excision of the germinal matrix, Winograd method, Bartlett method, knot technique, chemical matricectomy, and partial resection of the nail bed and matrix. [1][2][3][4][5][6][7] The Winograd technique is the most frequently used, which entails partial avulsion of the ingrown nail followed by surgical destruction of the lateral matrix to prevent nail regrowth in the affected area ( Figure 1). However, delays in wound healing, poor nail appearance, and recurrence of nail deterioration can be seen in patients treated with this technique. ...
... [3] The causes of ingrown nails are varied and include incorrect clipping of nails, wearing of tight-fitting shoes, obesity, trauma to the toes and/or nails, hyperhidrosis, fungal infection, and differential growth of nails and toes during puberty. [2,3,6] In our study, etiological factors in the majority of patients in both groups were incorrect clipping of nails and wearing of tight-fitting shoes. The other factors were obesity and hyperhidrosis. ...
... In this technique, relapse occurs if the germinal matrix is not sufficiently damaged or the matrix is inadequately excised. [6] In the knot technique, which is performed only on soft tissues, recurrence is unlikely because no germinal matrix damage or matrix excision is required. ...
Objective:
The aim of this study was to compare the Winograd and knot techniques based on efficiency, complication rate, surgery time, and amount of local anesthetic required. This study also aimed to determine the etiology of ingrown nails, whether due to involvement of the nail or soft tissue.
Methods:
Seventy-five patients with a total of 90 ingrown nails (stages 2 and 3) who presented at our clinic between 2012-2014 were included in this study. Patients were divided into 2 groups: those treated with the knot technique and those treated with the Winograd technique. Patients in both groups were evaluated for the amount of local anesthetic required, intraoperative pain, effectiveness of preventing/stopping hemorrhage, surgery time, complications, postoperative nail size, recurrence, nail deformities, and secondary surgery rates.
Results:
The mean surgical time, relapse rate, number of additional surgeries required, and amount of local anesthetic were significantly greater in the Winograd group than in the knot group. The mean nail diameter was significantly decreased, with a mean of 3 mm in the Winograd group. No statistically significant differences were found between the groups in the incidence of infection, intraoperative pain, hematoma, or nail deformity.
Conclusion:
This study demonstrated that the knot technique, consisting of wedge excision of soft tissue without affecting the nail itself, is a simple technique to treat ingrown nails with a lower complication rate and shorter surgical time. We believe that successful treatment of ingrown nails depends only on excision of soft tissue, with no need to operate on the nail bed.
... In higher stages of the condition, they preferred matricectomy plus curettage [16,17]. The rate of recurrence was noticed to be high with surgeries done with no nail matrix destruction, so different modes of treatment were recognized as procedures for permanent partial nail matrix destruction using phenol-10% and trichloroacetic acid [18,19]. ...
... The absolute contraindication to matrix resection is ischemia of digit, which can be a clinical symptom of systemic disease affection like diabetes or peripheral vascular diseases [18,[22][23][24]. In our study, seventeen cases with comorbidities were recruited: fourteen cases with diabetes and three cases with fungal infection. ...
... However, there is a slightly increased risk of postoperative infection [33]. ...
... Matricectomy can be performed surgically, chemically, with a laser, electrosurgically [33], or using radiofrequency [34]. Surgical excision involves making a deep incision in the nail bed using a surgical instrument. ...
Ingrown toenails, clinically known as onychocryptosis, represent a prevalent nail pathology. The clinical manifestation involves symptoms typical for a foreign body reaction and in severe cases, tissue hypertrophy with complications may occur. Key risk factors include improper nail care, trauma, obesity, tight footwear, poor foot hygiene, and genetic predisposition. The condition predominantly affects individuals between the first and the third decades of life and older adults, with a predilection for the great toe, especially the lateral skin fold. The Heifetz and Scholz classifications delineate the stages of ingrown toenails based on severity. Therapeutic approaches range from conservative procedures, such as taping, dental floss, gutter treatment, cotton nail cast, braces and super elastic wire to surgical interventions like partial or total nail avulsion, matricectomy and advanced techniques like the Vandebos procedure or the Winograd procedure. Although many studies have analysed available treatment methods, there is no consensus among specialists regarding the best therapeutic strategy. Complications include paronychia, infection, and scarring. A comprehensive therapeutic approach should consider clinical severity, patient preferences, and both conservative and surgical interventions, emphasizing the importance of larger randomized clinical trials to establish definitive guidelines.
... Ingrown toenails are a common nail problem that occurs when the lateral nail edge compresses the underlying soft tissue. This condition is more prevalent among adolescents and young adults, with a higher incidence among males, and it commonly affects the nails of the great toe [1][2][3][4][5][6]. Various factors can contribute to the de-velopment of ingrown toenails, such as improper nail trimming, trauma, tight footwear, infections, hyperhidrosis, obesity, and diabetes [6][7][8][9][10]. ...
... This condition is more prevalent among adolescents and young adults, with a higher incidence among males, and it commonly affects the nails of the great toe [1][2][3][4][5][6]. Various factors can contribute to the de-velopment of ingrown toenails, such as improper nail trimming, trauma, tight footwear, infections, hyperhidrosis, obesity, and diabetes [6][7][8][9][10]. The typical symptoms of an ingrown toenail include pain, inflamed skin, swelling, and the formation of pus. ...
... Causes of ingrown toenails include excessive skin surrounding the nail and excessive curvature(a hereditary factor), trauma, and external pressure(an acquired factor). These factors cause the edge of nail plate to dig into flesh, which causes pain and inflammation, and if not treated, symptoms gradually worsen and the formation of granulation tissue [1,3,4]. ...
... If symptoms are not severe, conservative treatment is performed using a gutter splint, dental floss, cotton-wick, or band. However, if symptoms are severe or persist, surgical treatment is performed [2,4,5]. Nevertheless, high recurrence rates have been reported after surgery, and thus, the author attempted to devise a more permanent surgical method. ...
Ingrown toenails are most common among school-age children and adolescents though they can be observed at any age. Causes of ingrown toenails are increased curvature, trauma, and external pressure. Treatment of ingrown toenails can be broadly characterized as conservative and surgical. Conservative treatment can be performed using various methods, such as a gutter splint, dental floss, and cotton. Surgical treatments may be divided into two main approaches; narrowing of the nail plate and debulking of periungual tissues. However, these various conservative and surgical treatments have high recurrence rates, and thus, the author used a permanent surgical method based on the use of a paronychium flap to treat a 15-year-old male adolescent with excessive periungual tissues and curved ingrown toenails who did not improve despite conservative and several surgical treatments over 4 years. Subsequently, toenail shape was maintained without recurrence 22 months after surgery, and there were no complaints of inflammation or pain while walking. This simple surgical method can be performed on patients with advanced ingrown toenails due to excessive periungual tissues and nail curvature and can be expected to have permanent effects.
... Ingrown toenail is a common and painful nail condition in which the nail plate penetrates the nail fold, causing swelling, pain, inflammation, and, in more severe cases, infection and formation of granulation tissue [1][2][3][4]. These painful symptoms can lead to an increase in morbidity and absenteeism from work [1,2]. ...
... The lateral fold of the big toe is the most often affected, although other toes can also be affected [5]. Etiologically, biomechanical changes, pathological nail plate curvatures, incorrect cutting, and type of shoes are the main causes of ingrown toenails [3,6,7]. ...
The Winograd technique is a common surgical treatment for ingrown toenails. Attempting to improve the results of this technique, two modifications were adopted: the incisional approach and the use of adhesive approximation strips. This study aimed to compare the conventional technique and the modified version based on (i) postoperative complications, (ii) healing time, (iii) recurrence rate, and (iv) overall patient satisfaction. A longitudinal, observational, and retrospective design was used, with a sample of 208 patients divided into the modified Winograd technique (n = 111) and the conventional Winograd technique (n = 97) in three clinics in Portugal, with follow-up periods of more than 15 years and 10 years, respectively. The modifications to the Winograd technique revealed fewer postsurgical complications, in terms of infections (1.8% vs. 20.62%, p < 0.010), recurrence rate (2.7% vs. 5.21%, p > 0.05), shorter recovery time (8.10 ± 0.76 vs. 14.51 ± 3.48 days, p < 0.001), and lower postoperative pain and better satisfaction with the functional and esthetic results, with the patient’s overall satisfaction, and with significant differences in relation to the conventional technique (p < 0.001). The modifications performed showed a lower rate of infection, decreased healing time, and better patient satisfaction, suggesting that it may be adopted in clinical practice for the treatment of stages II and III ingrown toenails.
... Zuber [8] discusses the procedures for ingrown toenail removal and procedural pitfalls and complications. Zuber states that a novice physician may need twenty procedures before being comfortable performing the procedure. ...
... Once the nursing faculty is satisfied the simulator in integrated into the appropriate simulationbased learning environment (SBLE). Figure 3 is the anatomy of a normal toenail [8]. A toenail consists of 1) nail plate (the visible part of nail); 2) nail bed (skin beneath the nail plate); 3) cuticle (tissue that overlaps the plate and rims the base of the nail); 4) nail folds (skin folds that frame and support the nail on three sides); 5) lunula (the whitish half-moon at the base of nail) and 6) matrix (hidden part of nail under cuticle) [10]. ...
This paper presents the development of an ingrown toenail removal simulator and a foreign object in-ear removal simulator. The ingrown toenail removal simulator mimics an inflamed toe and allows for nursing students to practice such procedures as wedge excision, ring block, and total ablation of the nail bed. The components of the ingrown toenail remover simulator are 1) support structure, 2) simulated toenail, and 3) simulated skin surrounding the toenail. Solid Edge CAD was used in the design and translated to an STL file for 3D printing. The ingrown toenail removal simulator is a 3D printed model using PLA (polylactic) filament. The foreign object removal simulator is used for training nursing students in the removal of foreign objects from ears, including ear wax. The components of the simulator are 1) a stand for mounting the ear and a hole simulating the ear canal and 2) an ear. The hole has been designed with a wavy contour to simulate the inner ear. SOLIDWORKS CAD software was used to model the ear canal and Tinkercad was used to model the mounting stand and remainder of the ear. The earwax removal simulator is a 3D printed model using PLA filament. Both simulators have gone through several design iterations and are currently in the final stage of development and ready for evaluation by the College of Nursing faculty. Once accepted, the simulators will be integrated into the College of Nursing's simulation-based learning experiences (SBLEs). SBLEs are an array of structured activities that represent actual or potential situations in education and practice. These activities allow participants to develop or enhance their knowledge, skills, and attitudes, or to analyze and respond to realistic situations in a simulated environment. Included in this paper is a description of the simulators, application in SBLEs in the College of Nursing, lessons learned, further research, and conclusions.
... 3 The use of electrodessication (ED) in matricectomy, first described in 1938, 2 is considered a simple and effective option. 4,5 It is one of the numerous methods of matricectomy, which include surgical excision, chemical ablation (with phenol, sodium hydroxide, or trichloroacetic acid), cryotherapy, carbon dioxide laser, and curettage. 4 While there has been no consensus as to which surgical technique is optimal, healing time as well as recurrence and complication rates are universally important outcomes in nail matricectomy. ...
... 2,16 Nail plate extraction alone has been associated with high recurrence rates ranging from 64% to 83%. 6 The matricectomy method using ED is a technique with a good learning curve and that produces consistent results. 5,9 ED uses electric current to generate heat and cause tissue dehydration and superficial destruction, thereby inducing coagulation necrosis and carbonization of cells, which are then ultimately removed via a combination of enzymatic degradation and phagocytosis. 13,17 The amount of ED needed can be reduced when most of the matrix tissue is first removed by an adjunct method such as dissection or curettage. ...
Nail matricectomy is indicated in the management of painful onychodystrophies, including recalcitrant onychocryptosis, onychogryphosis, onychauxis, and refractory onychomycosis. Although many matricectomy methods have been described, with phenolization being the best studied, no one method has clearly emerged as superior. We present a series of 14 patients who underwent a total of 18 matricectomies with either phenolization or electrodessication (ED) in a private dermatology office, and describe a simple and effective variation of the ED technique using a modified hyfrecator tip. A video demonstration of this technique is included. We also describe ED matricectomy in the context of a review of the literature, ascertaining recurrence rates, complication rates, healing time, and patient satisfaction. The nuances of technique specifics (such as the use of adjunct methods and antibiotics), as well as outcome predictors and measurements have been highlighted. We found ED to be comparable to other forms of matricectomy, with the advantages of ease of use, minimal complications, and good satisfaction rates.
... (4) While the aetiology of IGTN is not fully understood, contributing factors include genetic susceptibility, trauma, tight-fitting shoes and incorrect trimming of toenails. (5)(6)(7)(8) The disease process in IGTN comprises three stages: (5,6,9,10) stage 1 (inflammation), or the mildest form, which consists of swelling, erythema, oedema and swelling of the nail-fold, and pain with pressure; stage 2 (infection), or further swelling associated with seropurulent drainage, infection and ulceration of the nail fold; and stage 3 (granulation), or the most severe disease stage, which consists of chronic inflammation and granulation. ...
... (4) While the aetiology of IGTN is not fully understood, contributing factors include genetic susceptibility, trauma, tight-fitting shoes and incorrect trimming of toenails. (5)(6)(7)(8) The disease process in IGTN comprises three stages: (5,6,9,10) stage 1 (inflammation), or the mildest form, which consists of swelling, erythema, oedema and swelling of the nail-fold, and pain with pressure; stage 2 (infection), or further swelling associated with seropurulent drainage, infection and ulceration of the nail fold; and stage 3 (granulation), or the most severe disease stage, which consists of chronic inflammation and granulation. ...
INTRODUCTION: Ingrowing toenail (IGTN) or onychocryptosis is not uncommon in children and adolescents. However, there is a dearth of evidence in the literature on the management of IGTN in this age group. This study aimed to compare the results of nonoperative treatment for IGTN with that of operative treatment among children and adolescents. METHODS: All children and adolescents who were treated for IGTN at our institution between 2010 and 2014 were included for this retrospective study. Demographic data, treatment prescribed and outcome at six months after presentation were analysed. RESULTS: Overall, 199 patients were recruited. There were 123 (61.8%) boys and 76 (38.2%) girls. Median age was 14 years. Among 199 toes, 162 (81.4%) were treated nonoperatively, with nail care advice, topical antibiotics and daily cleansing. Only 37 (18.6%) toes were treated operatively. In the operative group, 23 (62.2%) patients underwent wedge resections, while the remaining 14 (37.8%) had total nail avulsions; for all patients, germinal matrices were preserved. At the six-month follow-up, there were 5 (3.1%) cases of recurrence in the nonoperative group when compared to 3 (8.1%) recurrences in the operative group. CONCLUSION: We recommend that IGTN in children and adolescents be treated in the first instance by nonoperative methods. Operative options can be considered for resistant cases or in case of recurrence of IGTN.
... Many investigators looked at the anatomical variations as possible risk factors in developing ingrowing toenail [1,10], such as the cross-sectional area of the toe, curvature ratio of the nail, lateral angle of the nail, medial angle of the nail, and many others [10,11,12]. Since the lateral edge is mostly affected [13,14], we think that internal pressure by the distal phalanx on the lateral edge of the nail could play a role in developing onychocryptosis. This pressure may be increase by lateral deviation of the distal phalanx. ...
... We believe that internal pressure by the distal phalanx and external pressure from the shoes could initiate the process of ingrown toenail mainly on the lateral edge. In our series we found that the lateral edge was involved in 85% of patients, a finding that confirm the findings of Delauro and Zuber [13,14]. ...
Objectives: To look at the early results of total knee replacement in King Abdulla University Hospital (KAUH), and decide whether we should continue offering this service or not? Methods: We retrieved the files of all patients who underwent total knee joint replacement in KAUH since its commissioning on 2002. We looked at certain epidemiological factors such as age, sex, weight and risk factors. We explained our preoperative plan, surgical techniques, types of prosthesis inserted, and the complications encountered. Results: The number of patients was 210, while the number of knees replaced were 267 joints. 80% of our patients were females, right and left side knees were replaced equally. The mean age of patients was 63.3 years, while the mean weight was 84.6 kgms. Only thirty patients were free of any co-morbidity, and the rest of them had at least one symptom of co-morbidity. The vast majority of patients have advanced primary osteoarthritis. Mobile bearing prosthesis were mostly used. The complications rate was 20%, most of which were in the form of superficial wound infection. Conclusions: Total knee replacement is a thriving surgery in Jordan, to keep going we must stick to the sound principles. Such a major surgery should be done in specialized centers. So far, we think that our results are satisfying and we will continue doing this type of surgery. © 2009 DAR Publishers/University of Jordan. All Rights Reserved.
... Ingrown nails commonly occur in adolescents and young adults; however, their incidence is higher in men [1,4]. Ingrown nails possibly occur owing to improperly trimmed nails, abnormal shape of nails, hypertrophy of the lateral nail folds, congenital or acquired nail disorders, nail infections, factors enhancing external pressure such as wearing tight shoes, genetic predisposition, obesity, trauma, subungual tumors, excessive sweating, and medications [5,6]. Recently, the role of foot anatomical disorders in ingrown nail development has been emphasized. ...
Introduction
Ingrown nail is a condition caused by the perforation of the periungual soft tissues on nail folds by the sides of nail plaque, causing inflammation and severe pain. Recently, the role of foot anatomical disorders in ingrown nail development has been emphasized.
Objectives
The main objective of this study aimed to determine whether foot deformities played significant roles in ingrown nail development with objective radiological parameters.
Methods
The study included 64 patients diagnosed with clinical ingrown nail and 71 patients as controls without any ingrown nail history. In both groups, we evaluated the bilateral foot radiographs of patients with ingrown nails for hallux valgus angle (HVA), interphalangeal angle (IPA), and intermetatarsal angle (IMA) associated with hallux valgus, and the calcaneal pitch angle (CPA), talohorizontal angle (THA), and talometatarsal angle (TMA) related to pes planus.
Results
No significant difference was found in terms of hallux valgus radiological measurements of HVA, IPA and IMA as well as pes planus radiological measurements of CPA and TMA values, when compared to controls. THA was statistically significantly higher in the control group (P = 0.025). There was a moderate strength positive relationship between ingrown nail stage and measured TMA for pes planus diagnosis (rho = 0.326; P = 0.04), yet there are no significant correlations between ingrown nail stage and other angles.
Conclusions
Therefore, we do not recommend foot anatomy correction in the prevention and treatment of ingrown nails, unless there is an accompanying foot deformity; however, pes planus is a foot deformity that can accompany patients with severely ingrown nails.
... 11,13 Matricectomy can be performed chemically or mechanically in the form of wedge resection, also known as the Winograd method and successful results of these two methods have been reported in ingrown toenails. 1,6,[11][12][13]16 In our study, chemical matricectomy with sodium hydroxide and Winograd method as mechanical matricectomy method were compared. In the literature, recurrence rates after ingrown toenail treatment with Winograd method were found to be 6% by Acar 11,20,21 In the present study, the recurrence rate in the chemical matricectomy group with sodium hydroxide was 6.45%, and it seems to be consistent with the literature. ...
... Therefore, Stage 4 was not possible. The Google search also highlighted a vast number of articles where the use of AgNO 3 for the treatment of HGT is mentioned only in passing [39][40][41][42][43][44]4,[45][46]30,[47][48][49][50][51][52]. Undoubtedly, there are others that were missed as its use was a minor component of the aim or objective of their article. ...
Silver compounds have been used in medicine to treat infections, open wounds, and chronic ulcers. Silver nitrate is used as a caustic, antiseptic, haemostatic and astringent agent. Using high-strength silver nitrate to treat the hypergranulation tissue complicating ingrown toenails is a customary practice by podiatrists in the United Kingdom. This study aims to identify what primary literature is available concerning the use of silver nitrate in this scenario, as anecdotal evidence suggests that its efficacy is limited. A scoping review of the literature was performed. The senior author searched electronic databases for primary studies and completed the independent screening process. The search identified 325 studies. After the rejection of those that were not relevant, a full-text review of 22 studies was performed. 21 studies were rejected as irrelevant, and one study was included. The second author then performed a free text search on Google and Google Scholar and found two further articles. In conclusion, this review found very little evidence to support the use of silver nitrate for treating the hypergranulation tissue affecting ingrown toenails.
... [4,9] Surgical partial matricectomy is a procedure involving lateral nail avulsion and electrocautery ablation of the germinal matrix under local anesthesia. [10] Since refractory paronychia with pain was observed in patients despite receiving multiple conservative treatments in the out-patient department of dermatology or oncology, we designed this retrospective study to assess whether an invasive management approach with surgical partial matricectomy would result in improved patient outcomes relating to wound pain, duration of treatment, and disease-free interval. This single-centre retrospective study aimed to evaluate the effect of surgical partial matricectomy in targeted therapy-induced paronychia in patients with NSCLC. ...
The development of targeted therapy has improved treatment outcomes for patients with non-small cell lung cancer (NSCLC). However, paronychia, a common adverse effect of targeted therapy, remains burdensome. Although conservative treatments for paronychia have been well reported in the literature, studies on the efficacy of surgical partial matricectomy for paronychia, are scarce. This study aimed to evaluate the effect of surgical partial matricectomy in targeted therapy-induced paronychia in patients with NSCLC. This retrospective cohort study included 11 patients with a total of 18 lesions on the big toes. Data on lung cancer stages, types and duration of targeted therapy, onset of paronychia, pain scale scores, conservative treatments, course of matricectomy, paronychia-free interval after matricectomy, and wound condition were collected from medical records. The Wilcoxon signed-rank test was used for analysis. The mean pain scale score after matricectomy was significantly lower than that after conservative treatments (1.00 ± 0.00 vs 2.94 ± 0.87; P < .001) and before treatment (1.00 ± 0.00 vs 3.06 ± 0.80; P < .001). The mean duration of matricectomy was significantly shorter than that of conservative treatments (3.22 ± 1.00 vs 56.56 ± 52.29 weeks; P < .001). Surgical partial matricectomy is an effective and enduring intervention for targeted therapy-related paronychia. It provides a shorter course of treatment, reduced pain, and improved appearance of the healed wound. Furthermore, surgical partial matricectomy could result in a better quality of life during targeted therapy than that of conservative treatments.
... In older persons, spicule formation can become a chronic pattern caused by reduced ability to care for their nails in addition reduced mobility and aging process causes the toe nail to thicken and this exerts pressure on lateral skin often becoming infected 5 . In grown toe nails are classified into three stages 6,7,8 . Stage I: of Inflammation: characterized by swelling of the nail fold, edema, erythema, and pain. ...
Aim: To compare partial nail avulsion followed by matricectomy either with phenol (80-88%) or with electro cautery for Stage 2 & 3 ingrown toenails for early and late postoperative complications. Methods: This study was conducted at department of surgery Nawaz Sharif social security teaching hospital Lahore for one year from 01-01-2018 to 31-12-2018. One hundred patients full filling inclusion criteria were included in the study and divided into two equal groups A and B. Partial nail avulsion done in both groups followed by chemical matricectomy with phenol (80-88%) in group A and patients in group B matricectomy done with electrocautry. Results: The mean age in group A is 19.7± 8.08 years and in group B is 20.20± 6.9 years, both groups comparable p-value (0.74).In early post-operative complications in group A 17(34%) patients and 14(28%) patients in group B experienced mild pain p-value is (0.66). 6(12%) of group A patients and 6(12%) of group B patients experienced moderate pain p-value (01). 1(2%) of group A patient and 2(4%) of group B patients experienced severe pain p-value (01). 02(4%) patients of group A and 02(4%) patients of group B had serous discharge p-value(01). 1(2%) of group B patients have purulent discharge, however, no patients in group A patients have purulent discharge p-value (01). 1(2%) patients of group A and 2(4%) patients of group B had recurrence at three months follow up p-value (01). 2(4%) patients of group A and 4(8%) patients of group B had recurrence at six months follow up p-value (0.68). Conclusion: Partial nail avulsion followed by matricectomy either with Phenol 80-88% or with electrocautry are comparable in early and late complications. Keywords: Ingrown toenails, partial matricectomy
... Техніка висічення нігтьового валика із м'яких тканин не стосується безпосередньо нігтя, вона полягає у видаленні значної частини уражених м'яких тканин із повним збереженням нігтьової структури і буває корисною при певних патологіях [3]. Інші нові методи матриксектомії: електрокаутеризація, радіочастотна абляція, абляція вуглекислотним лазером -ефективні, але досить вартісні [3,12,15,20,23,26,27]. ...
The study conducted proves that pelvic tilt is one of the root causes of onychocryptosis. Recovering the correct position of pelvic bones via manual methods restores the symmetrical position of the nail edge in the lateral nail fold of a toe, thus preventing any damage to the soft tissues of the lateral nail fold which is what causes onychocryptosis in the first place. By correcting pelvic bone imbalance via manual methods, we can therefore eliminate onychocryptosis without even touching the affected toe.
... Onychiptostosis, or ingrown toenails, appear when the lateral edges of the nail penetrate the skin and cause in ammation and pain. If left untreated, they can become infected [1]. The most frequent cause is a bad nail cut, hereditary factors, biomechanical or structural alterations of the foot, hyperhidrosis and the inappropriate use of footwear [2]. ...
Blackground
This study aims to compare 2 methods of anesthetic block in the first toe in patients with onychocryptosis.
Methods
A total of 70 ingrown toenails of the first toe in 59 patients underwent a digital anesthetic block using the V technique, while 70 ingrown toenails of the first toe in 57 patients underwent a digital anesthetic block using the H technique. As study variables, the effectiveness of the anesthetic block of the first toe was evaluated at 10 and 20 minutes after each of the techniques.
Results
An anesthetic block efficacy of 58.6% was observed at 10 minutes and 85.7% at 20 minutes in group V technique, while technique H observed efficacy at 10 minutes. 51.4% and 72.9% and at 20 minutes.
Conclusions
Technique V appears to be superior to technique H by 7.2% at 10 minutes and 12.8% at 20 minutes after anesthetic block.
Trial registrations
Ethical approval was obtained from the ethical committee of the University of Barcelona with the registration number IRB00003099 and the Ethical Committee for Research with Medicines from the Hospital Clínico de Barcelona with the number HCB / 2019/0051. All patients signed informed consents.
... Partial nail avulsion is generally used concurrently with surgical, electrocautery, or chemical matricectomy to prevent recurrences [40]. Chemical matricectomy is most commonly employed and may utilize phenol, sodium hydroxide, or trichloroacetic acid (TCA), [41]. ...
Ingrown toenail, or onychocryptosis, is a highly prevalent nail condition that occurs when the nail edge grows into the periungual dermis. It most frequently affects the hallux and has a biphasic presentation, being most common in the second and fifth decades. It is often painful and may be debilitating in severe cases. Risk factors include trauma, weight changes, poor nail-cutting technique, and hyperhidrosis. Both conservative and surgical treatments have been described, and choice of therapy is dependent on patient co-morbidities, severity, and associated symptoms. This review covers the epidemiology, risks factors, pathogenesis, evaluation, and staging of ingrown toenails, as well as, treatment options. Although there is an unmet need for clinical trials comparing therapies, current recommendations are to treat conservatively and then proceed to surgical therapies if symptoms persist.
... 9 Other complications are distal toe ischemia caused by prolonged application of the torniquet, damage the underlying tissues because overaggressive electrocautery to the nail matrix, infection, and lacerated nail bed when the nail is cut with the bandage scissors. 12 There was no complication of surgery found in our patient. ...
Ingrowing toenails (IT) is puncture of periungual skin by its surrounding nail plate. IT most frequently occurs in males aged 10-30 years. Pathogenesis of IT is multifactorial. Patients most commonly present with toe pain and may also complain erythema, swelling, or discharge from the nail edge. The clinical presentation of IT has been divided into three stages; stage I or inflammatory stages, stage II or abcess formation, and stage III or granulation tissue formation. IT is a nail disease with high reccurences that commonly seen in daily practice. Several treatment approaches ranging from conservative therapy (gutter splint) to surgical treatment (decompression technique). We report a case of IT in a 13-year-old boy that treated with decompression and gutter splint technique. The combination of this technique provides good results for IT and there was no recurrences after two months of observation.
... Simple nail avulsion is described in the literature but has high recurrence rate reaching up to 70%, 6 Partial nail avulsion along with chemical matricectomy using silver nitrate or phenol have been described. 1,4 One old study reported a high overall recurrence rate of 34% when the procedure was carried out by family physicians with an increase to 50% when carried out by general surgeons. 7 Other techniques involve the use of partial nail avulsion coupled with sharp pulse carbon dioxide laser matricectomy. ...
... За даними літератури та результатів наших спостережень стверджено, що незадовільні результати комплексного лікування мікотично-асоційованої оніхопатології (виникнення компресійних рецидивів) детермінуються неврахуванням патогенетичних та морфогенетичних чинників деструктивного оніхомікозу [11,12], технічними погрішностями опера-тивних втручань (неадекватний вибір методу резекції, травматичне виконання оніхектомії, недостатній обсяг резекції навколонігтьових тканин, відмова від проведення парціальної матриксектомії [13,14], фіксація залишків епоніхеальних тканин із звуженням епоніхеального каналу), відмовою від виконання симультанних оперативних втручань на глибшерозташованих структурах при поєднаних мікотично-асоційованих ураженнях, неефективним проведенням профілактичних до-та інтраопераційних заходів щодо поширення мікотичної інфекції на глибшерозташовані структури [11]. На основі даних щодо причин виникнення рецидиву оніхомікозу та вторинних компресійних уражень нами констатовано, що максимальна частота рецидивів піднігтьового гіперкератозу при поліоніхомікозі спостерігається на 12 місяць та третій рік післяопераційного періоду, що нерідко є показом для повторних оперативних втручань. ...
Relevance of the problem of ingrown nail (onychocriptosis, unguis incarnatus) in urgent outpatient purulent surgery is caused by the increased frequency of its occurrence, chronicity, complications, not uncommon early and late postoperative relapses. Conservative and orthopedic treatments of unguis incarnatus are not very effective while Dupuytren’s contracture, Emmert- Schmiden surgeries are very traumatic, disfi gure nail bone, distort anatomic and functional unity of a fi nger and in 2-20% cases (depending on absence or presence of onychocriptosis and fungal agents) cause relapse. Methods and results of ingrown nail surgical correction have been studied to improve the results of complex treatment. Over a fi ve-year period (2010-2015) 325 unguis incarnates surgeries in 198 men and 127 women aged 12-67 were performed. In 82 patients late relapses of onychocriptosis were confi rmed after previous surgeries at other clinics. Conservative treatment was recommended only at early stages of ingrowing. Surgical treatment was conducted with regard for pathological changes in eponychial fold according to recommendations for combining surgical treatment and conservative therapy. Upon subnychial scraping analysis of onychomycotic nails with secondary nail incarnation it was possible to confi rm dominance of dermatophytes (red trichophitia), while one third of cases were associated with mold and yeast-like fungi. Hyperkeratosis, erosion and destruction of central nail with secondary incarnation of the edges were typical for 89.1 % of trichophitis cases. Operative treatment consisted in nail excision or nail plate removal. Excision of pathologically changed epochonial tissues and partial marginal matricectomy in ingrown area were used as anti-relapse measures. Types of operative treatment applied may be divided into fi ve main groups: 1 – Emmert-Schmiden type surgeries (marginal excision of nail plate and eponychia with marginal removal of the growing part via partial matricectomy); 2 – Dupuytren’s contracture type surgeries (onychectomy – complete removal of nail plate); 3 – Bartlett type surgeries (local tissue plastic reconstruction); 4 – marginal resection of marginal section of nail plate; 5 – Meleshevych surgery; 6 – our modifi cations (with previous block-type eponychectomy). We have studied results of onychocriptosis surgeries of post-surgical type 1 correction in 84 patients, type 2 – in 66 patients, type 3 – in another 50 cases, type 4 – in 42 persons, type 5 – in another 27 patients, type 6 – in 56 patients (with the use of our modifi cation of surgical treatment). Three types of trichophytosis have been differentiated: frontal central – with erosion of up to 25% of nail area, subtotal – from 25 to 70% (without touching upon growth area), total – from 70 to 90% (with affected growth area). In 65 mycotic trichophitis patients with secondary nail incarnation a standard itraconazole pulse therapy was applied. Presence of onycholytic focuses and degradation of hyperkeratotic areas which results in lamination of a part of nail plate, proves feasibility of performing lowtrauma onychectomy on patients with trichophyton onychomycosis with secondary incarnation via onycholized structure with single-stage sequential removal of dermatophyte and ingrowth areas with changed eponychial folds. Relapse causes after Meleshevych, Emmert-Schmiden, Bartlett surgeries were technical faults of surgical tools, intraoperative nail bed trauma, faults of postoperative anti-relapse treatments, surgical area trauma, wearing of tight shoes, non-compliance with doctor’s recommendations as to correction of orthopedic pathology, onychomycosis.
... Cerrahi işleme kimyasal koterizasyonun eklenmesi ile nüks oranları belirgin oranlarda azalmıştır; çünkü germinal matriksin tam olarak yok edilmediği durumlarda nüks daha fazla görülmektedir 7,12 . Kısmi tırnak çekimiyle birlikte fenol veya sodyum hidroksit ile kimyasal koterizasyon yaygın kullanılan, başarılı bir yöntemdir 5,[12][13][14] . Fenol ile kimyasal koterizasyon uygulamasında nüks ve postoperatif ağrı oranları düşüktür. ...
Background and Design: This study was performed to assess the therapeutic outcomes of the surgical method, described by Winograd and chemical cauterization with sodium hydroxide in patients with Heifetz stage 2 and 3 ingrown toenail (recurrence, complication, improvement and time to regain activity). Materials and Methods: One-hundred patients who presented to the outpatient clinics of orthopedics, general surgery and dermatology with the complaints of pain, redness and discharge in the toenail between January 2010 and January 2012 and who failed to respond to conservative treatment and were diagnosed with Heifetz stage 2 and 3 ingrown toenail. Fifty patients underwent chemical cauterization with sodium hydroxide while 50 underwent Winograd surgery. Results: The patients were followed up for a year at 2-month intervals. While no recurrence was observed in patients who received chemical cauterization, five patients who underwent Winograd surgery had recurrence (p=0.022). Three patients receiving Winograd surgery were found to have superficial wound side infection on postoperative follow-up (p=0.08). Patients, who underwent chemical cauterization with sodium hydroxide, were detected to improve and return to normal activity in a shorter period. Conclusion: Chemical cauterization of the germinal matrix with 10% sodium hydroxide is a convenient method with a low rate of complication and recurrence compared to the Winograd surgery in the treatment of ingrown toenails.
... This method performs both digital nerve blocks in medial and lateral, uses approximately 5-10 ml. Local anaesthetic and 10 minutes pass before its effect starts [7]. In our study, we applied anesthesia only to the 5 mm. ...
An ingrown toenail is a frequently seen condition which affects life comfort negatively. Several surgical techniques have been defined in addition to medical methods for the treatment of ingrown toenail. This study evaluated the results of partial removal and percutaneous matricectomy in cases with a complaint of ingrown toenail that could not benefit from medical treatment. 21 patients who received surgical treatment for ingrown toenail were examined retrospectively. The patients’ age, sex, duration of complaint, length of time before going back to work, duration of recurrence and length of surgery were studied. It was found that partial removal and percutaneous matrix excision were easier, quicker and they allowed a quick healing period. © 2016, Journal of Clinical and Analytical Medicine. All rights Reserved.
... In the later stages, granulation tissue and lateral wall hypertrophy are formed and surgical treatment is needed. The objective of these surgical techniques is removal of the lateral nail plate and lateral matricectomy [5]. ...
Ingrown nail surgery is the one of the most common surgeries in outpatient clinics that are generally perfomed in response to patient complaints. Still, making simple observations, taking patient histories and conducting further tests are often neglected by outpatient clinics. Consequently, it is important to be aware if ingrown nail is associated with any underlying diseases that can lead to major complications.
In this article, we report on two cases ending in amputation that were performed with Winograd’s partial matrix excision procedure for ingrown nails. Such a complication is rare, unexpected, and most unwanted in forefoot surgery. After a detailed analysis of the situation, we discovered that both patients were smokers, and one of them had Buerger’s disease. These conditions led to the ingrown nails in addition to poor wound healing.
This case report emphasizes the fact that even when performing minor procedures, obtaining a detailed history and conducting an examination are of paramount importance. Patient selection is also a considerable factor, especially for patients who are smokers, who may experience a worst case surgical scenario.
... Low attainability to surgical clinics had led more conservative treatment for stage II and III. In the practice of general practitioners for ingrowing nails, the antibiotic treatment with warm soapy water application were generally preferred [8]. However increased antibiotic usage and high recurrence rates are important problems for ingrowing nails. ...
Objectives: The aim of this study is to evaluate the risk factors and treatment outcomes of patients with ingrowing nails in an urban region.
Methods: This descriptive prospective study was performed in a General Surgery outpatient clinic in an urban region for 6 months. The data about sex, risk factors, age, history of previous medication were obtained. Body mass index, the ratio of second toe to the length of hallux, the ratio of the diameter of hallux to width of hallux nail were calculated. The ingrowing nails with stage II and III were treated by Winograd method. The patients were followed for recurrences and complications for nearly 6 months.
Results: Total 61 patients were treated. Female to male ratio was 33/28. The man age was 24.8±11.8. The mean BMI was 28.5±5.3. Tight shoes, improper nail trimming were the leading etiological factors. Total 44 patients had a history of at least one time antibiotic usage history. Symptoms were found to be increased after pregnancy (66.7%). Lateral localization was significantly higher in patients with longer second toe than the hallux. There were 5 postoperative infections (8.2%) and only one (1.6%) recurrence.
Conclusion: Ingrowing nail is an important problem because of increased risk factors in urban region. Winograd method which is an easy method with low recurrence and high patient satisfaction can be preferred. J Clin Exp Invest 2014; 5 (1): 45-47
... Like many conditions, IGTNs have been classified into various stages. Zuber 11 describes a three-stage classification This article considers the many conservative and surgical management options for ingrowing toenails. It is designed to be used as a guide to inform the reader of the multiple options available for ingrowing toenail treatment and also to highlight the level of strength of evidence of these options from the available literature. ...
Podiatry Now
a critical review of the evidence base of the many conservative and surgical options for ingowing toenails.
The aim of the surgical intervention is the elimination of infections, ulceration and pain caused by ingrown nails (unguis incarnatus).
A surgical intervention is recommended for ingrown nails (the large toenail is most frequently affected) in stage III and higher (according to the Mozena classification) as well as in cases of nail plate defects and recurrences.
In cases where a disturbance of wound healing is expected and general contraindications for surgery.
The surgical approach incorporates a half-moon-shaped skin incision and a straight longitudinal nail incision. Both incisions extend to the bone. A wedge-shaped piece of tissue is removed and after thorough curettage and rinsing the wound is closed using transungual single-button sutures.
Regular changes of wound dressing, relief of the affected ray by immobilization during wound healing. An antibiotic therapy is only indicated in selected cases.
Between 1 January 2013 and 1 January 2023 a total of 50 Emmertʼs plastic surgery operations (15 women and 35 men) were performed at the Klinikum Vest, Knappschaftskrankenhaus Recklinghausen. The average age of the patients was 50.6 years.
The mean follow-up time was 63 months. The outcome and satisfaction of the patients were evaluated according to the self-reported foot and ankle score (SEFAS). The total point count (median value) of the evaluated SEFAS score was 44.
The loss of the digits is a traumatic event. This research deals with the diseases of the thumbs and the big toes, including the surgery.
This Biblical verse shows that in the character described the amputations of the thumbs and the great toes were carried out "But Adoni—bezek fled; and they pursued after him, and caught, and cut off his thumbs and his great toes" (Judges 1:6).
Was some disease responsible for this type of surgery?
The are numerous diseases that can affect the thumb and the great toe. Some of these diseases require the surgery. Including the amputation, the reconstruction, and the replantation.
In the Biblical character described evaluation of various diseases that may lead to the amputations was not found. A conclusion that follows is that the brutal amputation of the thumbs as and the big toes took place.
In the recent years, the diagnostic possibilities have been validated through scientific research and have shown medicinal value in the diagnostics and the management of various conditions related to the various diseases of the thumb and the great toe.
Thus, the brutal amputation of the digits has accompanied the humans during the long years of our existence.
Background and objective: Surgery for an ingrown toenail of the great toe is a common procedure that requires an anesthetic neuromuscular blockade of the entire digit. Various digital block techniques have been described, but no evidence-based recommendations on the best choice have emerged. We aimed to compare the V block to the H block in this type of surgery.
Material and methods: Multicenter randomized clinical trial in patients undergoing onychocryptosis surgery between February 2018 and February 2020. We recorded sex, age, foot intervened, type of blockade used (H block or V block), efficacy 10 and 20 minutes after injection of the anesthetic, and number of attempts.
Results: A total of 140 surgeries to treat ingrown toenails were assigned to 2 groups (H block or V block) of 70 patients each. The same anesthetic, dose, and volume were used in all cases. The V technique produced a better neuromuscular block in 7.2% more cases at 10 minutes and in 12.8% more at 20 minutes.
Conclusions: Both block techniques are safe and effective. The V block is a good alternative to the H block in patients undergoing surgery to treat an ingrown toenail.
Resumen
Introducción: La cirugía en onicocriptosis del primer dedo del pie es un procedimiento común que requiere un bloqueo anestésico completo del dedo. Existen diferentes técnicas, pero no hay recomendaciones basadas en la evidencia sobre el mejor tipo de técnica de anestesia. En este contexto, nuestro objetivo fue evaluar si el bloqueo anestésico en V presenta ventajas respecto al bloqueo en H.
Material y Métodos: Se realizó un estudio observacional, prospectivo y multicéntrico en pacientes sometidos a cirugía de onicocriptosis entre febrero de 2018 y febrero de 2020. Se distribuyó a los pacientes aleatoriamente en dos grupos. Se recogieron los siguientes datos: sexo, edad, tipo de bloqueo según técnica (técnica H o técnica V), eficacia de la técnica a los 10 y 20 minutos posteriores a la infiltración, pie afectado y número de refuerzos anestésicos.
Resultados: Se incluyeron 140 intervenciones quirúrgicas sobre uñas con onicocriptosis, que se dividieron en dos grupos. Se compararon las variables después de realizar los distintos abordajes anestésicos con el mismo agente anestésico, dosis y volumen. A 70 intervenciones se les asignó la técnica H y a otras 70 intervenciones se les asignó la técnica V. Al analizar los tiempos de eficacia, se observó que la técnica V fue mejor en un 7,2% a los 10 minutos y en un 12,8% a los 20 minutos frente a la técnica H.
Conclusiones: Los dos métodos de bloqueo anestésico son seguros y eficaces. La técnica V es una buena alternativa a la técnica H en pacientes sometidos a cirugía de onicocriptosis.
Ingrown toenails are a common reason for referral to orthopedics and podiatry clinics. Recurrence and infection are common complications in ingrown toenail surgery. This study investigates the effect of an electrocautery matrixectomy on the recurrence and clinical outcomes in the Winograd technique applied in ingrown toenail surgery and whether prophylactic antibiotic use is necessary for these surgeries. One hundred forty-three patients who underwent surgery for ingrown toenails were analyzed retrospectively. Eighty-two patients underwent the Winograd procedure with electrocautery matrixectomy, whereas 61 patients underwent the Winograd procedure. While 78 patients were given prophylactic antibiotics, 65 patients were not. Patient satisfaction was evaluated with a surgical satisfaction questionnaire (SSQ). A visual analog score was used to evaluate the pain. Recurrence was observed in 3 toenails in the Winograd and electrocautery groups, while recurrence was observed in 9 toenails in the Winograd group ( P = .018). In both groups, there was no statistically significant difference between the infection rates between patients who took antibiotics and those who did not ( P > .05). There was no statistically significant difference between the groups in terms of SSQ scores ( P > .05). It was observed that the surgery performed had a positive effect on pain, and this effect was statistically highly significant in both groups ( P < .05). The outcomes of the present study suggest that the addition of an electrocautery matrixectomy to the Winograd technique in the surgical treatment of symptomatic Ingrown toenails may decrease recurrence rates. Additionally, this study showed that oral antibiotics, when used in addition to Ingrown toenail surgery, do not reduce postoperative morbidity.
Athletic trainers, physical therapists, and team physicians have differing roles when providing care, yet often need to collaborate. Athletic trainers and physical therapists use a variety of therapeutic modalities and manual therapy techniques in conjunction with rehabilitation exercises to improve outcomes. Clinicians must be knowledgeable of the scientific rationale for each modality to choose the most effective treatment for the specific condition and stage of recovery. The team physician should be familiar with the use of common procedures in an athletic training room. Here, we review the most current evidence and the basic methods encountered in athletic training room settings.
Bedah kuku termasuk tindakan yang tidak rutin dilakukan pada praktik kedokteran. Tindakan ini menjadi tantangan bagi para klinisi karena memerlukan tindakan bedah rapi yang teliti. Bedah kuku dapat dilakukan untuk penegakan diagnosis maupun terapi berbagai kasus tumor jinak atau ganas, kasus-kasus inflamasi, dan trauma pada kuku. Beragam jenis tindakan bedah kuku memiliki prinsip yang berbeda sesuai dengan patologi kelainan kuku dan letak pada unit kuku yang terkena. Pembedahan pada kuku terutama pada matriks kuku sangat berisiko menimbulkan komplikasi seperti distrofi kuku. Tujuan pembedahan seringkali tidak tercapai pada pengambilan jaringan biopsi, karena spesimen tidak memadai untuk dilakukan pemeriksaan histopatologis yang disebabkan tindakan bedah yang tidak tepat. Oleh karena itu, penting bagi para klinisi untuk dapat memahami berbagai teknik bedah kuku.
Bij een ingegroeide teennagel of dwangnagel (unguis incarnatus, ingrowing toenail) is er sprake van ingroei van de distale rand van de nagel (meestal de laterale) in het omliggende nagelbed. De teen is pijnlijk rood en gezwollen. Naarmate de afwijking langer bestaat, kan er door chronische ontsteking of prikkeling granulatieweefsel (‘wild vlees’) ontstaan. Dit kan leiden tot een pussige afscheiding.
Bij een ingegroeide teennagel is de distale rand van de nagel (meestal de laterale) ingegroeid in het omliggende nagelbed. De teen is pijnlijk rood en gezwollen. Naarmate de afwijking langer bestaat, kan door chronische ontsteking of prikkeling granulatieweefsel (‘wild vlees’) ontstaan. Dit kan leiden tot een pussige afscheiding.1,2
For decades, every year sees a wide number of articles in the podiatry, dermatology, general, and orthopedic literature about treatment of ingrown toenails. There is still a debate about the cause of ingrowing toenails. Some are convinced that the nail is responsible for the condition and thus will intervene on the plate itself; others are prone to the idea that the periungual soft tissues are at fault and favor a surgical procedure on them. The literature offers numerous studies showing the superiority of one technique over another, but none of them showed that the procedure is performed on the same type of ingrowing toenails. Many studies are open, non-randomized with short follow-up. Despite various trials, there is disagreement on which procedures give the most consistent results. Some do not hesitate to compare a conservative technique with an aggressive radical surgical procedure. And of course, comparing a surgical procedure you are used to, to another one with which you are not familiar, will skew the final results. One should also remember that mostly all surgical procedures are operator dependent, and that very easy ones to perform will certainly get higher success rates. There is indeed a no “cureall” technique for ingrowing toenails, but mainly two different approaches: narrowing the plate or debulking of soft tissues. Both excellent, as long as they are performed in appropriate cases. One should carefully examine each patient’s toe and decide which technique would suit best according to his/her skills. Sometimes, several types of procedures may be performed on the same ingrowing toenail to obtain best results. All procedures cited in this chapter have high cure rates as long as they are properly performed.
Introduction: A problem of onychocryptosis is a common ailment, that afflicts people of every gender and age. Aim of the study: The purpose of the study work was to prepare and validate a questionnaire, in order to value the quality of life of patients with ingrown toenail and to find a tool helpful in objective assessment of results of treatment. Material and methods: International Questionnaire of Quality of Life Typical for Onychomycosis was analyzed and modified for needs of assessment of onychocryptosis. The research was conducted among 105 people with onychocryptosis aged between 18 and 70. Preparation and validation of the questionnaire was conducted in accordance with international regulations. The following statistic tests were used in the validation process: exploratory factor analysis, estimation with principal component method with varimax, dependent samples T-test, independent samples T-test and calculation of Cronbach's alfa and Spearman rho. Results: The results of exploratory factor analysis separated three aspects: physical, emotional and social. All the aspects are characterized by high reliability. Conclusions: Because of the high ratio of Cronbach's alfa, we can acknowledge the questionnaire as reliable. Moreover, it can be used as a base for researches of quality of life of patients suffering from ingrown toenail as well as for the assessment of therapeutic effects.
Background: Many techniques for the treatment of ingrown toenails have been described in the medical literature. Surgical removal of the nail plate with partial matricectomy is associated with the lowest recurrence rates. Shape-memory alloy (KD wire) has shown promising results for the treatment of ingrown toenails. However, the results of long term follow-up or a comparison with surgical treatment have not been reported, and the adequate removal time of the wire remains unknown.
Introduction: A poorly described aspect of onychocryptosis - the main cause for nail unit surgeries - is how to perform its surgical closure. The present article describes a new technique denominated alpha stitch that allows the straightening out of the nail fold by positioning it at or below the nail plate's level. Objective: To demonstrate the benefits of the alpha stitch surgical closure technique in the surgical matricectomy for onychocryptosis. Methods: Twenty patients with onychocryptosis grades II and III underwent surgical matricectomy and were followed up for six months. The surgical closure was performed using the alpha stitch technique. Results: A total of 27 lateral nail folds were operated, with 81.8% yielding the expected result, and 18.1% presenting uncertain outcomes. Conclusions: The alpha stitch allows the proper healing of the straightened out nail fold, which is positioned at or below the nails plate's level, with good results, fast recovery, minimal morbidity and a small number of recurrences. The technique can also be used in surgical procedures involving other nail disorders.
Background: An ingrown nail is a common condlition of inflammation and infection that can occur when nails are clipped too much or pressure is applied by tight shoes. In Korea, a study on the success of tube insertion after nail guttering has been reported, but studies including other treatments are lacking.
Nail surgery is a special field of dermatosurgery that requires comprehensive knowledge of nail structure and function. The main indications of the nail unit surgery are pigmentary changes, subungual tumors and nail plate deformities. Authors describe an universal algorithm of nail surgery techniques performed in selected diseases of the nail apparatus.
Removal of the nail matrix is indicated in a variety of recalcitrant conditions in which the growth of the nail plate causes mechanical problems such as recurrent onychocryptosis or pain due to pinching or pressure. Before performing a matricectomy, the physician must consider the use of nonsurgical methods and the possible contraindications to surgery. Once the decision for matricectomy is made, the physician should then utilize the modality with the least morbidity and greatest convenience for the patient. A wide repertoire of methods of matricectomy is available for use; all methods, when performed properly, have similar high rates of cure.
The authors present a successful method for surgically correcting ingrown toenails by using radio wave technique. A review of the literature is also presented.
Sixty-six patients with ingrowing toenails were randomly assigned to one of two treatment groups and followed up for 16 to 30 months after surgery. In group A 39 nail edges in 32 patients were treated by excision of the nail edge and chemical ablation of germinal matrix edge with 70% aqueous phenol. There were 34 patients in group B, in whom 46 nail edges and germinal matrix edges were surgically excised. In group A recurring symptoms developed in four (10%) nail edges, necessitating further surgery, and asymptomatic spicules developed in seven (18%) nail edges. Two (4%) nails in group B required reoperation and spicules developed in 10 (22%). Both procedures were performed as outpatient surgery, relieved pain and infection, and were acceptable to patients. At an average 2-year follow-up, both procedures yielded comparable results that were superior to those of simple avulsion.
An ingrown toenail acts as a foreign body, causing an inflammatory reaction and opening the way to secondary infection. Treatment consists of removing the offending portion of the nail and taking steps to prevent recurrence. The treatment should be simple to minimize expense, operative risks, and posttreatment disability. The most important step in preventing recurrence is teaching the patient the correct way to trim toenails.
Incomplete destruction of the nail matrix may result in partial recurrence of the nail. This occurs most frequently at the lateral ends of the proximal nail fold. A procedure that provides permanent, satisfactory results consists of careful dissection of the recurrent nail fragments followed by local phenol cauterization.
The etiology, prevention, and previous therapies for ingrown toenails are presented. A simple, quick, relatively painless method for treating ingrown toenails is described, in which a cotton wick saturated with iodine tincture is inserted into the affected sulcus, separating the nail plate from the skin. Granulation tissue is treated with a cotton applicator saturated with a 50 percent silver nitrate solution. This method works on more than 80 percent of the ingrown toenails seen by this dermatologist, and is well tolerated by the patient.