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Exley V, Jones K, O'Carroll G, Watson J, Backhouse M. A systematic review and meta-analysis of randomised controlled trials of surgical treatments for ingrown toenails part II: healing time, post-operative complications, pain, and participant satisfaction. J Foot Ankle Res 2023; 16:55. [PMID: 37674170 PMCID: PMC10481456 DOI: 10.1186/s13047-023-00655-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/15/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND When performing nail surgery, clinicians must choose from a multitude of procedures and variations within each procedure. Much has been published to guide this decision making, but there are a lack of up to date robust systematic reviews to assess the totality of this evidence. METHODS Five databases (MEDLINE, Embase, CINAHL, Web of Science and CENTRAL) and two registers (Clinicaltrials.gov and ISRCTN) were searched to January 2022 for randomised trials evaluating the effects of a surgical intervention(s) for ingrown toenails. Two independent reviewers screened records, extracted data, assessed risk of bias and certainty of evidence. Data on co-primary outcomes of symptom relief and symptomatic regrowth were presented in our first paper. This paper presents data for the secondary outcomes and further discussion. RESULTS Of 3,928 records identified, 36 randomised trials were included in the systematic review. Healing time appears to be reduced with shorter application of phenol. A reduced healing time was also apparent was with the addition of curettage, although this may also increase the risk of post-operative bleeding and pain. Post operative bleeding was also reportedly lower in people who received local anaesthetic with epinephrine but no tourniquet. Use of phenol with nail bed excision may decrease the risk of infection. Lower pain scores were reported when using partial matrixectomy and surgical interventions with phenol. Shorter duration of pain was reported with phenolisation and wedge resection. Participant satisfaction was high overall. CONCLUSION This second paper reports secondary outcomes from a robust systematic review of randomised trials on surgical treatment of ingrown toenails. Despite the large volume of clinical trials conducted on the topic, few clinical conclusions can be drawn due to the poor quality of these studies. Further high-quality clinical trials are needed to answer fundamental questions in the surgical treatment of ingrown toenails.
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Affiliation(s)
- Victoria Exley
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Katherine Jones
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Grace O'Carroll
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Judith Watson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Michael Backhouse
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
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Wang Y, Zhang N, Li X, Li X, Chen C, Zhang J, Hu Y. A novel cosmetic approach for partial matricectomy in treating ingrown toenails. J Cosmet Dermatol 2023; 22:2542-2547. [PMID: 37128829 DOI: 10.1111/jocd.15762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/12/2023] [Accepted: 03/27/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Toenails play a great part in protecting toes and peripheral soft tissues, simultaneously playing a cosmetic role. The ideal treatment should result in a functional and aesthetic outcome. OBJECTIVE To describe a novel, aesthetic and minimally invasive method to treat ingrown toenail. METHODS We retrospectively analyzed 436 lesions of 395 ingrown toes in 353 patients with a mean age of 26.0 ± 13.4 (range 10-55) from June 2014 to March 2020 in our department. A novel cosmetic approach for partial matricectomy in treating ingrown toenails was undergone. The average follow-up time was 27.5 ± 2.8 months. The average period prior to work resumption, recurrence rate, and infection rate were measured. Mean pain Visual Analogue Scale (VAS) and Mean satisfaction VAS were used to evaluate the foot appearance. RESULTS The average period prior work resumption was 2.2 ± 2.1 days (range, 0-7 days). The recurrence rate was 1.6% (7 lesions in 6 patients) at more than 2 years of follow-up. There was no critical complication except infection (0.46%). Mean pain VAS reduced from a preoperative score of 7.7 ± 1.5 points (range, 6-10 points) to a postoperative 3-day score of 2.2 ± 1.0 points (range, 1-4 points; p < 0.001) while Mean satisfaction VAS improved from 1.5 ± 1.3 points (range, 0-3 points) to 9.2 ± 0.6 points (range, 8-10 points; p < 0.001). CONCLUSION Our proposed approach is minimally invasive relative to conventional methods, which can achieve comparable efficacy to treat ingrown toenails with granulation tissue. Therefore, it can serve as another option to treat this specific type of ingrown toenails.
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Affiliation(s)
- Yifan Wang
- Department of Foot and Ankle Surgery, The Second Hospital of Shandong University, Ji'nan, P. R. China
| | - Ning Zhang
- Department of Foot and Ankle Surgery, The Second Hospital of Shandong University, Ji'nan, P. R. China
| | - Xiaolu Li
- Department of Foot and Ankle Surgery, The Second Hospital of Shandong University, Ji'nan, P. R. China
| | - Xiaohan Li
- Department of Foot and Ankle Surgery, The Second Hospital of Shandong University, Ji'nan, P. R. China
| | - Cong Chen
- Department of Foot and Ankle Surgery, The Second Hospital of Shandong University, Ji'nan, P. R. China
| | - Jiadong Zhang
- Department of Foot and Ankle Surgery, The Second Hospital of Shandong University, Ji'nan, P. R. China
| | - Yong Hu
- Department of Foot and Ankle Surgery, The Second Hospital of Shandong University, Ji'nan, P. R. China
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Exley V, Jones K, O'Carroll G, Watson J, Backhouse M. A systematic review and meta-analysis of randomised controlled trials on surgical treatments for ingrown toenails part I: recurrence and relief of symptoms. J Foot Ankle Res 2023; 16:35. [PMID: 37301845 PMCID: PMC10257290 DOI: 10.1186/s13047-023-00631-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/18/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Ingrown toenails are a common nail pathology. When conservative treatments are ineffective, a surgical approach is often utilised. Despite recent narrative reviews, there is a need for an up-to-date and rigorous systematic review of surgical methods for treating ingrown toenails. METHODS Five databases (MEDLINE, Embase, CINAHL, Web of Science and CENTRAL) and two registers (Clinicaltrials.gov and ISRCTN) were searched to January 2022 for randomised trials evaluating the effects of a surgical intervention(s) for ingrown toenails with a follow-up of at least 1 month. Two independent reviewers screened records, extracted data, assessed risk of bias and certainty of evidence. RESULTS Of 3,928 records identified, 36 (3,756 participants; 62.7% males) surgical interventions were included in the systematic review and 31 studies in the meta-analysis. There was very low quality evidence that using phenol with nail avulsion vs nail avulsion without phenol reduces the risk of recurrence (risk ratio [RR] 0.13 [95% CI 0.06 to 0.27], p < 0.001). No favourable effect was observed between chemical or surgical vs conservative management (0.55 [0.19 to 1.61], p = 0.280; 0.72 [0.33 to 1.56], p = 0.410), chemical or surgical vs other (e.g., CO2 laser, electrocautery) (1.61 [0.88 to 2.95], p = 0.120; 0.58 [0.25 to 1.37], p = 0.220), chemical vs surgical (0.75 [0.46 to 1.21], p = 0.230), surgical vs surgical (0.42 [0.21 to 0.85]), chemical vs chemical (0.19 [0.01 to 3.80], p = 0.280), surgical vs surgical + chemical (3.68 [0.20 to 67.35], p = 0.380), chemical vs surgical + chemical (1.92 [0.06 to 62.30], p = 0.710), local anaesthetic vs local anaesthetic + adrenaline (1.03 [0.22 to 4.86], p = 0.970), chemical timings 30 s vs 60 s (2.00 [0.19 to 21.41]) or antibiotics vs no antibiotics (0.54 [0.12 to 2.52], p = 0.430). Central toenail resection was the only procedure to significantly relieve symptoms (p = 0.001) but data were only available up to 8 weeks post-surgery. CONCLUSION Despite the high number of publications, the quality of research was poor and the conclusions that can be inferred from existing trials is limited. Phenolisation of the nail matrix appears to reduce the risk of recurrence following nail ablation, and with less certainty 1 min appears to be the optimum time for application. Despite this being a widely performed procedure there remains a lack of good quality evidence to guide practice.
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Affiliation(s)
- Victoria Exley
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Katherine Jones
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Grace O'Carroll
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Judith Watson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Michael Backhouse
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
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Surgical Matricectomy Versus Phenolization in the Treatment of Ingrown Toenails: A Randomized Controlled Trial. Dermatol Surg 2023; 49:231-236. [PMID: 36735804 DOI: 10.1097/dss.0000000000003692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Treatment of ingrown toenail includes various nonsurgical and surgical treatments. However, there is no consensus on the ideal first-choice treatment. OBJECTIVE To compare phenolization versus surgical matricectomy (SM) after lateral nail plate avulsion in terms of efficacy, recurrence rates, postoperative outcomes, and cosmesis. METHODS The authors enrolled 45 consenting patients and randomized them into 2 groups (Group 1 = phenolization and Group 2 = SM) using stratified block randomization and followed them up at 1 week, 1 month, and 6 months. RESULTS The median percentage improvement in pain visual analog scale (VAS) score was comparable between the 2 groups ( p = 0.793). The mean photo VAS showed significant improvement in Group 1 at 1 week ( p = 0.00) and 1 month ( p = 0.02) but not at 6 months ( p = 0.44). The median number of days for pain relief ( p = 0.169), for healing ( p = 0.192), and for resuming work ( p = 0.136) were not significantly different between the 2 groups. The time required to regain normal morphology was significantly longer in Group 2 ( p = 0.006). None of the patients in either group presented with recurrence at 6 months and 1 year. The authors observed failure of treatment in 1 patient in Group 2. CONCLUSION Both procedures were equally efficacious, had minimal complications, and showed no recurrence at 6 months and 1 year.
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Kim J, Kim K, Kwon M, Cho J, Seilern Und Aspang J. The association between foot alignment and the development of ingrown toenails: A case-control study in a young adult military population. Foot Ankle Surg 2022; 28:119-125. [PMID: 33676822 DOI: 10.1016/j.fas.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND This case-control study aimed to explore an association between foot alignment and development and presentation of the ingrown toenail. METHODS Radiographs were evaluated for hallux interphalangeal angle (HIA), hallux valgus angle (HVA), talonavicular coverage angle (TNC), talo-first metatarsal (Meary's) angle, and calcaneal pitch angle (CP), as well as medial sesamoid position in a cohort of 103 young and healthy patients (mean age of 20.5 years) with ingrown toenails. A control group of 63 patients was included, and the radiographic parameters were compared. Subgroup analysis was performed in patients with lateral (n = 65) or medial (n = 38) nail fold involvement. RESULTS The overall study group demonstrated a larger TNC and Meary's angle and smaller CP than the control group, while no significant difference was found regarding the HIA and HVA. The lateral nail fold group had a larger HIA when compared to the medial nail fold group. Multiple regression analysis revealed that for ingrown toenail development, the only risk factor was a decrease in the CP. In the case of lateral nail fold involvement, an increase in the HIA found to be the only factor. CONCLUSION A lower medial longitudinal arch seems to be a predisposing factor in developing an ingrown toenail. The lateral nail fold involvement was associated with lateral deviation of the distal phalanx. The result of this study could provide information on prevention, treatment, recurrence, and patient counseling of an ingrown toenail in otherwise young and healthy individuals.
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Affiliation(s)
- Jaeyoung Kim
- Hospital for Special Surgery, New York, NY 10021, USA.
| | - Kyungho Kim
- Department of Orthopaedic surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Minsoo Kwon
- Department of Orthopaedic Surgery, Armed Forces Daejeon Hospital, Daejeon, Republic of Korea
| | - Jaeho Cho
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, Republic of Korea
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Vinay K, Narayan V, Thakur V, Choudhary R, Narang T, Dogra S, Varthya SB. Efficacy and safety of phenol based partial matricectomy in treatment of onychocryptosis: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2021; 36:526-535. [PMID: 34913204 DOI: 10.1111/jdv.17871] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/26/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
Chemical matricectomy is an established treatment modality of onychocryptosis. In this meta-analysis we studied the efficacy and safety profile of phenol-based matricectomy. We performed an electronic data base search of PubMed, EMBASE and gray literature using the search terms "(onychocryptosis OR ingrown toe nail) AND (phenol OR chemical matricectomy)" from inception till 31-12-2020, for controlled clinical trials with phenol in one of the treatment arms and at least 10 participants in each arm. From the initial search of 335, eighteen articles were included in the final analysis. There were a total of 1655 patients, of which 856 received phenol as an intervention modality. We found that nail matrix phenolisation was associated with a 49 fewer number of recurrences per thousand patients compared to other modalities (OR: 0.28 - 0.57, CI 95%). It also had a reduction of 175 cases of discharge or hemorrhage per thousand patients compared to other modalities (OR:0.25, 95% CI:0.14 to 0.45). However, we found that TCA and NaOH based matricectomies fared better compared to phenol in incidence of postoperative discharge and hemorrhage. Patients also experienced less pain (257 fewer number per 1000, OR: 0.52, 95% CI:0.43 to 0.63). Nearly half of the included studies had some concerns about the risk of bias. As of now, phenol matricectomy combines a low recurrence rate with favourable adverse effect profile and is the preferred modality for matricectomy in grade II and III onychocryptosis.
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Affiliation(s)
- Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Vignesh Narayan
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Vishal Thakur
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012.,Department of Dermatology, Venereology and Leprosy, Himalayan Institute of Medical Sciences, Dehradun, India, 248140
| | - Rajat Choudhary
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Shoban Babu Varthya
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India, 342001
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Karacan E, Ertilav D. Comparison of Vandenbos procedure or Winograd method for ingrown toenail. Jt Dis Relat Surg 2021; 32:414-419. [PMID: 34145819 PMCID: PMC8343846 DOI: 10.52312/jdrs.2021.36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/07/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study aims to compare the outcomes of the Winograd method and Vandenbos procedure used to treat an ingrown toenail. PATIENTS AND METHODS Between January 2017 and February 2020, a total of 145 patients (65 males, 80 females; mean age: 31.45 years; range, 13 to 61 years) who were treated with Winograd or Vandenbos procedure for an ingrown toenail were retrospectively analyzed. Of the patients, 70 underwent the Winograd method (Group 1) and 75 underwent the Vandenbos procedure (Group 2). Postoperative Visual Analog Scale (VAS) scores, demographic data, recurrence/complication rates, and satisfaction of patients were recorded. RESULTS The mean recovery time was 11.8±2.6 days in Group 1 and 18.0±2.1 days in Group 2 (p<0.001). The mean VAS score was 3.9±0.7 in Group 1 and 7.2±1.0 in Group 2 (p<0.001) during the first postoperative week. Of the patients, 56 (80%) of 70 patients in Group 1 and 74 (98%) of 75 patients in Group 2 were satisfied with the surgery (p<0.001). In terms of cosmetics, 60 (85%) of the patients in Group 1 and 74 (98%) of the patients in Group 2 were satisfied (p=0.003). Recurrence was observed in 10 (14%) patients in Group 1, while no recurrence was observed in Group 2. Six (8.7%) patients in Group 1 and one (1.3%) patient in Group 2 developed complications. CONCLUSION Low recurrence rates, high satisfaction, and good cosmetic results can be achieved with the Vandenbos procedure, while recovery time and return to work are faster with the Winograd method. The appropriate surgical technique should be selected based on the individual patient.
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Affiliation(s)
- Erkan Karacan
- Aydın Devlet Hastanesi Genel Cerrahi Kliniği, 09100 Efeler, Aydın, Türkiye.
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A fast and effective solution for ingrown toenail: Creation of a 2-mm space between tissue and nail by sutureless lateral longitudinal excision. Arch Dermatol Res 2021; 313:799-803. [PMID: 33433721 PMCID: PMC8443495 DOI: 10.1007/s00403-020-02177-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 11/12/2020] [Accepted: 12/07/2020] [Indexed: 11/24/2022]
Abstract
Nails have both functional and aesthetic importance. Undertreatments cause frequent recurrences affecting its functionality, while over-treatment spoils the aesthetic view. To describe the most practical and aesthetic method to treat ingrown toenail. All patients with ingrown toenail who applied to outpatient clinics of General Surgery Department between 2013 and 2019 were enrolled. A 2-mm space between tissue and nail by lateral longitudinal excision was created with only minimal matricectomy, under local anaesthesia. A total of 2334 surgical procedures were performed in 2118 patients. Recurrence rate was 1.7% during 36-month follow-up, most (70.7%) in younger men (22 years). The location of the lesions (right/left, medial/lateral or bilateral) did not show difference (p > 0.05 for each). Predisposing factors were tight-fitting footwear (4.5%), incorrect nail-trimming (3%), genetic tendency (2.8%), obesity (2.1%) and trauma (0.75%); but each was p > 0.05. Mean operation time was 3 min. There was no important complication, except hematoma (0.89%) and infection (0.68%). Mean healing time was 10 days and patients returned to daily activities in 3 days. Longitudinal excision with minimal matricectomy technique provides all dead tissue and diseased parts of nail and soft tissue to be removed. It is simple, cost-effective, satisfactory and aesthetic. SBU/23.01.2019/B.10.1.TKH.4.34.H.GP.0.01/7 (retrospectively registered).
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Stewart CR, Algu L, Kamran R, Leveille CF, Abid K, Rae C, Lipner SR. Patient Satisfaction with Treatment for Onychocryptosis: A Systematic Review. Skin Appendage Disord 2020; 6:272-279. [PMID: 33088811 DOI: 10.1159/000508927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/15/2020] [Indexed: 01/30/2023] Open
Abstract
Onychocryptosis, or ingrown nail, is a common condition in which the nail plate penetrates the nail fold, often resulting in inflammation and pain. Nonsurgical and surgical treatments are utilized, but patient satisfaction with these therapies has not been well studied. The purpose of this study was to systematically review the available literature describing patient-reported outcomes of onychocryptosis treatments. We performed a search of the literature published prior to May 22, 2019. Articles were included in the review if primary data were presented, patient-reported outcome measures (PROMs) were used, and nail involvement was specifically examined. From the initial search, 18 studies were included in the final analysis. Patients receiving both nonsurgical and surgical interventions reported high levels of overall satisfaction; however, most studies used ad hoc measures rather than validated PROMs, providing little granular information on the impact of treatment on quality of life (QoL). This review affirms that treatment for onychocryptosis results in satisfactory outcomes for patients; however, increased efforts are needed to understand the impact of therapy on patient QoL as assessed by validated outcome measure that accurately assess patients' cosmetic, physical, and social difficulties.
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Affiliation(s)
| | - Leah Algu
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rakhshan Kamran
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Cameron F Leveille
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Khizar Abid
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
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The Treatment of Ingrown Nail: Chemical Matricectomy With Phenol Versus Aesthetic Reconstruction. A Single Blinded Randomized Clinical Trial. J Clin Med 2020; 9:jcm9030845. [PMID: 32244966 PMCID: PMC7141528 DOI: 10.3390/jcm9030845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/10/2020] [Accepted: 03/18/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In onychocryptosis surgery, incisional and non-incisional matricectomy is indicated according to the stage. The chemical matricectomy with 88% phenol solution is the gold standard and a wedge resection is indicated for more advanced stages. The aesthetic reconstruction has the advantages of the incisional procedure without eponychium incisions and an effectiveness similar to the chemical matricectomy with phenol. OBJECTIVE To compare the recurrence and the healing time between the chemical matricectomy with phenol and the aesthetic reconstruction. METHODS A comparative, prospective, parallel, randomized, and one-blinded clinical trial was registered with the European Clinical Trials Database (EudraCT) with identification number 2019-001294-80. Thrity-four patients (56 feet) with 112 onychocryptosis were randomized in two groups. Thirty-six were treated with chemical matricectomy with phenol and 76 with aesthetic reconstruction. Each patient was blind to the surgical procedure assigned by the investigator. The primary outcome measurements were healing time and recurrence. The secondary outcome measurements were post-surgical bleeding, pain, inflammation, and infection rate. RESULTS The aesthetic reconstruction procedure presents a shorter healing time (8.2 ± 1.4 days vs. 21.3 ± 3.1 days; p < 0.001) with a similar recurrence rate (p = 0.98). Post-operatory bleeding, pain, inflammation, and the infection rate did not show significant differences (p > 0.05). CONCLUSIONS The aesthetic reconstruction presents a shorter healing time, favoring the patients' recuperation, with a recurrence similar to the chemical matricectomy with 88% phenol solution.
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11
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Thakur V, Vinay K, Haneke E. Onychocryptosis – decrypting the controversies. Int J Dermatol 2020; 59:656-669. [DOI: 10.1111/ijd.14769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/21/2019] [Accepted: 12/18/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Vishal Thakur
- Department of Dermatology, Venereology, and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology, and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
- Department of Dermatology Inselspital University of Bern Bern Switzerland
| | - Eckart Haneke
- Department of Dermatology Inselspital University of Bern Bern Switzerland
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Abstract
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.
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13
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Sánchez LC, Zalacaín-Vicuña AJ. Onychoplasty with 1064-nm Laser: Matrixectomy for Treatment of Ingrown Toenails. J Am Podiatr Med Assoc 2019; 109:401-406. [PMID: 31599675 DOI: 10.7547/17-008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Onychocryptosis is a common pathology treated by podiatry medical services, and in a considerable percentage, surgical procedures are required to achieve a solution. There are multiple surgical approaches for ingrown toenails, both incisional procedures and nonincisional procedures, such as chemical matrixectomies and physical matrixectomies using carbon dioxide laser. This study presents a surgical procedure for onychocryptosis using a physical matrixectomy with a 1064-nm laser applied by means of a 400-μm optical fiber and surgical removal of the posterior cauterized tissue to achieve healing by primary intention. This technique was performed on 30 patients with onychocryptosis affecting the great toe (Mozena stages I and IIa), and all of the patients were followed up postoperatively for 12 months. The patients reported minimal postoperative pain, quicker surgical postoperative healing, rapid return to activities of daily living, and minor postoperative recurrence compared with previous studies using incisional procedures and chemical matrixectomies.
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Affiliation(s)
- Lluís Castillo Sánchez
- Department of Clinical Sciences, Section of Podiatry, Faculty of Medicine and Health Sciences, Barcelona University, Barcelona, Spain
| | - Antonio Jesús Zalacaín-Vicuña
- Department of Clinical Sciences, Section of Podiatry, Faculty of Medicine and Health Sciences, Barcelona University, Barcelona, Spain
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Acar E. Winograd Method Versus Winograd Method With Electrocoagulation in the Treatment of Ingrown Toenails. J Foot Ankle Surg 2018; 56:474-477. [PMID: 28242214 DOI: 10.1053/j.jfas.2017.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Indexed: 02/03/2023]
Abstract
An important component of the Winograd surgical method for an ingrown toenail is total excision of the associated germinal matrix. However, this might not always be accomplished with the procedure. We hypothesized that the surgical results might be improved by adding electrocoagulation of the germinal matrix to the Winograd method. The objective of the present study was to compare the recurrence, satisfaction, and complication rates of the Winograd method with those of the Winograd method with electrocoagulation. We retrospectively evaluated the records of 102 patients with single Heifetz stage 2 or 3 ingrown toenails who had undergone surgery from January 2013 to October 2014 using 1 of these 2 methods. Of the 102 patients, 50 (49%) underwent the Winograd method and 52 (51%) underwent the Winograd method with electrocoagulation. The mean follow-up period of our patients was 12 (range 6 to 22) months. An ingrown toenail recurred in 3 patients (6%) in the Winograd group and in no patient in the Winograd with electrocoagulation group (p = .04). Among the patients in the Winograd group, 46 (92.0%) were satisfied or very satisfied. Among the patients in the Winograd plus electrocoagulation group, 49 (94.2%) were satisfied or very satisfied (p = .04). No complications developed in either group. In conclusion, the Winograd method for ingrown toenails results in high satisfaction rates, low recurrence rates, and low complication rates. The addition of electrocoagulation of the germinal matrix to the Winograd method could result in even lower recurrence rates, while maintaining high patient satisfaction and without increasing the risk of complications.
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Affiliation(s)
- Erdinc Acar
- Orthopedist and Hand Surgeon, Department of Orthopedics and Traumatology, Hand and Upper Extremity Surgery Division, Konya Necmettin Erbakan University Meram School of Medicine, Konya, Turkey.
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Temel M, Çelik E, Özden R, Doğramacı AÇ, Doğramacı Y, Uruç V. Tırnak Batmalarının Tedavisinde Kama Şeklinde Çıkarımla Birlikte Yeni Bir Sütür Tekniğinin Sonuçları. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2016. [DOI: 10.17944/mkutfd.287665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Guler O, Tuna H, Mahirogullari M, Erdil M, Mutlu S, Isyar M. Nail Braces as an Alternative Treatment for Ingrown Toenails: Results From a Comparison With the Winograd Technique. J Foot Ankle Surg 2015; 54:620-4. [PMID: 25937564 DOI: 10.1053/j.jfas.2015.04.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Indexed: 02/03/2023]
Abstract
Ingrown toenails are one of the most frequent nail disorders and can be treated with conservative or surgical approaches. Although discovered a long time ago, the available data are still very limited on the potential effectiveness of nail braces for ingrown toenail treatment. In the present retrospective study, we compared nail braces with surgical wedge excision using the Winograd technique with respect to the time to return to work, recurrence, interval to recurrence, and patient satisfaction. A total of 159 patients were divided into the nail brace (n = 74; mean age 29.51 ± 8.48 years) and Winograd technique (n = 85; mean age 26.95 ± 8.06 years) groups. In the nail brace group, the mean time to return to work (4.15 ± 1.07 days) was significantly shorter than that in the Winograd technique group (13.8 ± 2.26 days; p < .001). Patient satisfaction was significantly greater in the nail brace group (94.6%) compared with the Winograd technique group (82.4%; p = .018). Of the 159 patients, 6 (8.1%) in the nail brace group and 8 (9.4%) in the Winograd technique group developed recurrence; however, this difference was not statistically significant (p > .05). A statistically significant difference was observed in the mean interval to recurrence (12.46 ± 1.60 versus 13.24 ± 2.48 months, respectively; p = .031). The progression-free follow-up periods for the nail brace and Winograd technique groups were 15.45 ± 0.22 months (95% confidence interval 15.02 to 15.88) and 17.18 ± 0.29 months (95% confidence interval 16.61 to 17.84), respectively. We have concluded that the use of nail braces is an appropriate alternative treatment of ingrown toenails with high patient satisfaction, fast recovery times, and a low recurrence rate.
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Affiliation(s)
- Olcay Guler
- Assistant Professor, Department of Orthopedics and Traumatology, Medipol University, Medical Faculty, Istanbul, Turkey.
| | - Hamide Tuna
- Dermatologist, Department of Dermatology, Nisa Hospital, Istanbul, Turkey
| | - Mahir Mahirogullari
- Professor, Department of Orthopedics and Traumatology, Medipol University, Medical Faculty, Istanbul, Turkey
| | - Mehmet Erdil
- Associate Professor, Department of Orthopedics and Traumatology, Medipol University, Medical Faculty, Istanbul, Turkey
| | - Serhat Mutlu
- Orthopedic Surgeon, Department of Orthopedics and Traumatology, Kanuni Sultan Suleyman Training Hospital, Istanbul, Turkey
| | - Mehmet Isyar
- Assistant Professor, Department of Orthopedics and Traumatology, Medipol University, Medical Faculty, Istanbul, Turkey
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Harada K, Yamaguchi M, Matsuzawa M, Shimada S. Ingrown nail with a giant granulation tissue successfully treated with the gutter method. Int J Dermatol 2015; 54:e191-2. [PMID: 25772908 DOI: 10.1111/ijd.12760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kazutoshi Harada
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.
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Huang JZ, Zhang YJ, Ma X, Wang X, Zhang C, Chen L. Comparison of wedge resection (Winograd procedure) and wedge resection plus complete nail plate avulsion in the treatment of ingrown toenails. J Foot Ankle Surg 2014; 54:395-8. [PMID: 25441276 DOI: 10.1053/j.jfas.2014.08.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Indexed: 02/03/2023]
Abstract
The present retrospective study compared the efficacy of wedge resection (Winograd procedure) and wedge resection plus complete nail plate avulsion for the treatment of ingrown toenails (onychocryptosis). Two surgical methods were performed in 95 patients with a stage 2 or 3 ingrown toenail. Each patient was examined weekly until healing and then at 1, 6, and 12 months of follow-up. The outcomes measured were surgical duration, healing time, recurrence rate, the incidence of postoperative infection, and cosmetic appearance after surgery. Of the 95 patients (115 ingrown toenails) included in the present study, 39 (41.1%) underwent wedge resection (Winograd procedure) and 56 (59%), wedge resection plus complete nail plate avulsion. The mean surgical duration for wedge resection (Winograd procedure) and wedge resection plus complete nail plate avulsion was 14.9 ± 2.4 minutes and 15.1 ± 3.2 minutes, respectively (p = .73). The corresponding healing times were 2.8 ± 1.2 weeks and 2.7 ± 1.3 weeks (p = .70). Recurrence developed in 3 (3.2%) patients after wedge resection (Winograd procedure) and in 4 (4.2%) after wedge resection plus complete nail plate avulsion. In addition, postoperative infection occurred in 3 (3.2%) patients after wedge resection (Winograd procedure) and 2 (2.1%) after wedge resection plus complete nail plate avulsion. Both of the surgical procedures were practical and appropriate for the treatment of ingrown toenails, being simple and associated with low morbidity and a high success rate. However, cosmetically, wedge resection (Winograd procedure) would be the better choice because the nail plate remains intact.
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Affiliation(s)
- Jia-Zhang Huang
- Department of Orthopedics, Huashan Hospital Fudan University, Shanghai, China
| | - Yi-Jun Zhang
- Department of Orthopedics, Huashan Hospital Fudan University, Shanghai, China
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital Fudan University, Shanghai, China.
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital Fudan University, Shanghai, China
| | - Chao Zhang
- Department of Orthopedics, Huashan Hospital Fudan University, Shanghai, China
| | - Li Chen
- Department of Orthopedics, Huashan Hospital Fudan University, Shanghai, China
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Partial matricectomy with curettage and electrocautery: a comparison of two surgical methods in the treatment of ingrown toenails. Dermatol Surg 2014; 40:1132-9. [PMID: 25229780 DOI: 10.1097/dss.0000000000000129] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND An ingrown toenail is a common, painful, and debilitating condition. OBJECTIVE This study aims to compare 2 surgical methods (partial matricectomy with curettage and electrocautery) in the treatment of ingrown toenails. MATERIALS AND METHODS A total of 92 ingrown nails of the big toe in 86 patients underwent partial matricectomy with curettage, whereas 57 ingrown nails of the big toe in 52 patients underwent partial matricectomy with electrocautery. RESULTS Recurrence was observed in 2 toenails in the partial matricectomy with curettage group, whereas no recurrence was observed in the partial matricectomy with electrocautery group (p > .05). The mean period of postoperative pain was 2.3 and 3.1 days in the curettage group and the electrocautery group, respectively (p < .05). There was a significant difference in the duration of scar tissue inflammation (p < .05). CONCLUSION Both surgical methods are safe treatment modalities with a high success rate. Partial matricectomy, which is achieved using curettage, seems to be superior to electrocautery in respect of reduced inflammation and duration of pain.
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AlGhamdi KM, Khurram H. Nail Tube Splinting Method Versus Lateral Nail Avulsion With Phenol Matricectomy. Dermatol Surg 2014; 40:1214-20. [DOI: 10.1097/dss.0000000000000154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Barreiros H, Matos D, Goulão J, Serrano P, João A, Brandão FM. Using 80% trichloroacetic acid in the treatment of ingrown toenails. An Bras Dermatol 2014; 88:889-93. [PMID: 24474095 PMCID: PMC3900337 DOI: 10.1590/abd1806-4841.20132296] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 01/14/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Ingrown nails are a very common problem. There are different stages of disease and diverse therapeutic options. Phenol and sodium hydroxide are commonly used agents for chemical matricectomy but both frequently entail excessive healing times. OBJECTIVE This prospective study aimed mainly to evaluate the efficacy of partial nail avulsion and selective chemical cauterization of the matrix using 80% TCA in the treatment of the ingrowing nail. METHODS One-hundred-and-thirty-three patients with 197 ingrown toenails were included in this study. Preoperatively, we tried to find predisposing factors to the disease. In the postoperative period, patients were evaluated for potential complications at days 3, 30, 180, 270 and 360. Pain was measured before surgery, as well as 24 hours and 72 hours after surgery. RESULTS There were only 3 cases (out of 197) of ingrown nail recurrence. Preoperatively, we found the presence of drainage in 82% of patients, which, following the first visit after surgery, was reduced to 19%. Persistent granulation tissue was found in 3% of the patients (versus 75% prior to surgery). The most frequent predisposing factors for the ingrown nail were excessive trimming of the lateral nail plate (63%), plantar hyperhidrosis (58%) and heavy nail folds (39%). Pain was substantially reduced after surgery. CONCLUSION It is assumed that chemical procedures for the ingrown toenail are associated with delayed healing times but our results demonstrated quick recovery. Using 80% TCA for selective matricectomy in the ingrown toenail is an effective, quick and easy method.
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Pérez-Rey J, Mediavilla-Saldaña L, Martínez-Nova A. Exploring postoperative outcomes for ingrown toenails. NaOH vs wedge resection techniques. Dermatol Surg 2014; 40:281-7. [PMID: 24447206 DOI: 10.1111/dsu.12427] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ingrown (or ingrowing) toenail is a commonly used term for onychocryptosis, in which the nail becomes inserted into the lateral fold of the toe. The resulting effect on a person's health, well-being, and ability to work suggests the importance of clear treatment guidance, but little consensus exists. OBJECTIVE To explore postoperative recovery after surgery for ingrown toenails using chemical (sodium hydroxide (NaOH)) or mechanical (wedge resection) matricectomy and thus contribute to understanding within the field on which to base treatment guidelines. METHODS One hundred sixty-one procedures were undertaken, 94 using NaOH and 67 using wedge resection. Four measures of postoperative recovery were recorded: recurrence, infection, time to discharge, and number of postoperative visits. RESULTS Patients treated with NaOH had lower rates of recurrence (p = .048) and infection (p = .03) than those treated with wedge resection, and time to discharge was shorter (p = .02), but they had more postoperative visits (p = .003). CONCLUSION Low rates of recurrence and infection and short postoperative recovery time were found after both procedures, with a small advantage with treatment with NaOH. The authors argue for the value of clinical intervention using matricectomy in early stages to avoid complications resulting from granulation tissue growth.
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Korkmaz M, Cölgeçen E, Erdoğan Y, Bal A, Ozyurt K. Teenage patients with ingrown toenails: treatment with partial matrix excision or segmental phenolization. Indian J Dermatol 2013; 58:327. [PMID: 23919026 PMCID: PMC3726903 DOI: 10.4103/0019-5154.113970] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Ingrown toenails (IT) is a very common problem leading to significant associated morbidity. The articles related to phenolization for matrix removal in teenagers with IT are not enough in the foot surgery literature. Aims: To compare the postoperative recovery periods, complication rate, and tolerability of partial matrix excision and segmental phenolization in teenagers with IT. Materials and Methods: Thirty-nine patients (13-17 years) with 48 IT were randomly divided into two groups and were treated with partial matrix excision (Group I) and segmental phenolization (Group II). We assessed the recurrence rates, postoperative complications, duration of analgesic usage, and time to return to daily activities. Results: There was no significant difference between the demographic and clinical data of the two groups. Three patients in Group I and two patients in Group II experienced moderate pain postoperatively. These patients used analgesics for 3 days. The rates of postoperative complications and recurrences between the two groups showed no statistically significant difference (P = 0.688). The time to return to normal daily activities was significantly shorter in Group II patients than in Group I patients (P < 0.05). Conclusions: Partial matrix excision is a very safe model of therapy in the surgical treatment of teenagers with IT. It has low recurrence rate and minimal postoperative morbidity. We concluded that segmental phenolization is also as safe as partial matrix excision in the treatment of IT and patients return to their daily activities in less time with this treatment modality.
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Affiliation(s)
- Murat Korkmaz
- Department of Orthopedics Surgery, Bozok University Medical Faculty, Yozgat, Turkey
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Ceren E, Gokdemir G, Arikan Y, Purisa S. Comparison of Phenol Matricectomy and Nail-Splinting With a Flexible Tube for the Treatment of Ingrown Toenails. Dermatol Surg 2013; 39:1264-9. [DOI: 10.1111/dsu.12230] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Perez CI, Maul XA, Catalina Heusser M, Zavala A. Operative Technique with Rapid Recovery for Ingrown Nails with Granulation Tissue Formation in Childhood. Dermatol Surg 2013; 39:393-7. [DOI: 10.1111/dsu.12048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Küçüktaş M, Kutlubay Z, Yardimci G, Khatib R, Tüzün Y. Comparison of Effectiveness of Electrocautery and Cryotherapy in Partial Matrixectomy After Partial Nail Extraction in the Treatment of Ingrown Nails. Dermatol Surg 2013; 39:274-80. [DOI: 10.1111/dsu.12068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Becerro de Bengoa Vallejo R, Losa Iglesias ME, Viejo Tirado F, Serrano Pardo R. Cauterization of the germinal nail matrix using phenol applications of differing durations: A histologic study. J Am Acad Dermatol 2012; 67:706-11. [DOI: 10.1016/j.jaad.2012.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 04/19/2012] [Accepted: 05/01/2012] [Indexed: 10/28/2022]
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Cordoba Diaz D, Losa Iglesias ME, Cordoba Diaz M, Becerro de Bengoa Vallejo R. Enhanced removal of phenol with saline solution over alcohol: an in vitro study. Dermatol Surg 2012; 38:1296-301. [PMID: 22861059 DOI: 10.1111/j.1524-4725.2012.02459.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Phenol cauterization is a chemical equivalent often chosen for treatment of ingrown toenails. Many reports describe intraoperative irrigation, or lavage, of the wound with various types of alcohol to neutralize any remaining phenol. There are conflicting reports in the literature as to whether true neutralization or merely effective removal of excess phenol is needed. OBJECTIVE The aim of our study was to analyze the suitability and effectiveness of ethyl alcohol versus sterile saline when used in a lavage step after phenol application in the treatment of ingrown toenails. METHODS We performed an in vitro study using human skin and a diffusion cell apparatus to measure the amount of phenol recovered after lavage with ethyl alcohol or sterile saline. RESULTS When the wound was irrigated with ethyl alcohol, the total phenol recovered after two irrigation washes was 55.7% of the original amount initially used in treatment, compared with 80.4% when sterile saline solution was used for irrigation. CONCLUSION Alcohol and sterile saline solution do not neutralize phenol but dilute it and aid in its removal. We found that saline solution recovered more phenol than when washing with alcohol and recommend its use instead of alcohol for irrigation purposes after chemical matrixectomy.
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Affiliation(s)
- Damian Cordoba Diaz
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, Universidad Complutense de Madrid, Madrid, Spain
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Kose O, Guler F, Gurcan S, Arik HO, Baz AB, Akalin S. Cosmetic results of wedge resection of nail matrix (Winograd technique) in the treatment of ingrown toenail. Foot Ankle Spec 2012; 5:241-4. [PMID: 22547536 DOI: 10.1177/1938640012444729] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this retrospective study is to evaluate the cosmetic results of wedge resection of the nail matrix (Winograd technique) in the treatment of ingrown toenail. MATERIALS AND METHODS This study retrospectively reviewed medical charts of 68 patients with 75 ingrown toenails who underwent surgical correction with the Winograd technique between January, 2008, and December, 2009, at the Orthopaedics and Traumatology Department, Antalya Education and Research Hospital. For the final follow-up, patients were contacted by telephone and completed a telephone questionnaire. Recurrence, cosmetic results, and satisfaction of the patients were the major outcome measures. RESULTS There was recurrence in 9 patients (13.2%). The mean recurrence time was 6.7 months (range = 2-12 months). All recurrences involved the lateral border of the toenail. Cosmetic ratings were statistically lower in female patients (P = .005). The reasons for poor and acceptable cosmetic results were proximal-incision scar and narrowing of the nail plate. CONCLUSION Wedge resection of nail matrix has a considerably high recurrence rate. Furthermore, narrowing of the nail plate is a disadvantage of this procedure. All patients should be informed about the possibility of recurrence and disfigurement in their toenails (narrow nail plate). Particularly, female patients who care about the cosmesis may be dissatisfied with this surgical technique.
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Affiliation(s)
- Ozkan Kose
- The Orthopaedics and Traumatology Department, Antalya Education and Research Hospital, Antalya, Turkey.
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Harada K, Yamaguchi M, Miyajima S, Kawamura T, Shibagaki S, Shimada S. Gutter method: noninvasive management of ingrown nails caused by epidermal growth factor inhibitor treatment. Clin Exp Dermatol 2012; 37:703-4. [PMID: 22548530 DOI: 10.1111/j.1365-2230.2012.04358.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K Harada
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.
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Abstract
BACKGROUND Ingrowing toenails are a common problem in which part of the nail penetrates the skinfold alongside the nail, creating a painful area. Different non-surgical and surgical interventions for ingrowing toenails are available, but there is no consensus about a standard first-choice treatment. OBJECTIVES To evaluate the effects of non-surgical and surgical interventions in a medical setting for ingrowing toenails, with the aim of relieving symptoms and preventing regrowth of the nail edge or recurrence of the ingrowing toenail. SEARCH METHODS We updated our searches of the following databases to January 2010: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, MEDLINE, and EMBASE. We also updated our searches of CINAHL, WEB of SCIENCE, ongoing trials databases, and reference lists of articles. SELECTION CRITERIA Randomised controlled trials of non-surgical and surgical interventions for ingrowing toenails, which are also known by the terms 'unguis incarnatus' and 'onychocryptosis', and those comparing postoperative treatment options. Studies must have had a follow-up period of at least one month. DATA COLLECTION AND ANALYSIS Two authors independently selected studies, assessed methodological quality, and extracted data from selected studies. We analysed outcomes as risk ratios (RR) with 95% confidence intervals (CI). MAIN RESULTS This is an update of the Cochrane review 'Surgical treatments for ingrowing toenails'. In this update we included 24 studies, with a total of 2826 participants (of which 7 were also included in the previous review). Five studies were on non-surgical interventions, and 19 were on surgical interventions.The risk of bias of each included study was assessed; this is a measure of the methodological quality of several characteristics in these studies. It was found to be unclear for several items, due to incomplete reporting. Participants were not blinded to the treatment they received because of the nature of the interventions, e.g. surgery or wearing a brace on the toe. Outcome assessors were reported to be blinded in only 9 of the 24 studies.None of the included studies addressed our primary outcomes of 'relief of symptoms' or 'regrowth', but 16 did address 'recurrence'. Not all of the included studies addressed all of our secondary outcomes (healing time, postoperative complications - infection and haemorrhage, pain of operation/postoperative pain, participant satisfaction), and two studies did not address any of the secondary outcomes.Surgical interventions were better at preventing recurrence than non-surgical interventions with gutter treatment (or gutter removal), and they were probably better than non-surgical treatments with orthonyxia (brace treatment).In 4 of the 12 studies in which a surgical intervention with chemical ablation (e.g. phenol) was compared with a surgical intervention without chemical ablation, a significant reduction of recurrence was found. The surgical interventions on both sides in these comparisons were not equal, so it is not clear if the reduction was caused by the addition of the chemical ablation.In only one study, a comparison was made of a surgical intervention known as partial nail avulsion with matrix excision compared to the same surgical intervention with phenol. In this study of 117 participants, the surgical intervention with phenol was significantly more effective in preventing recurrence than the surgical intervention alone (14% compared to 41% respectively, RR 0.34, 95% CI 0.17 to 0.69).None of the postoperative interventions described, such as the use of antibiotics or manuka honey; povidone-iodine with paraffin; hydrogel with paraffin; or paraffin gauze, showed any significant difference when looking at infection rates, pain, or healing time. AUTHORS' CONCLUSIONS Surgical interventions are more effective than non-surgical interventions in preventing the recurrence of an ingrowing toenail.In the studies comparing a surgical intervention to a surgical intervention with the application of phenol, the addition of phenol is probably more effective in preventing recurrence and regrowth of the ingrowing toenail. Because there is only one study in which the surgical interventions in both study arms were equal, more studies have to be done to confirm these outcomes.Postoperative interventions do not decrease the risk of postoperative infection, postoperative pain, or healing time.
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Affiliation(s)
- Just A H Eekhof
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden,
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Álvarez-Jiménez J, Córdoba-Fernández A, Munuera PV. Effect of curettage after segmental phenolization in the treatment of onychocryptosis: a randomized double-blind clinical trial. Dermatol Surg 2011; 38:454-61. [PMID: 22122781 DOI: 10.1111/j.1524-4725.2011.02232.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Segmental phenolization for the treatment of onychocryptosis has a number of disadvantages, resulting from the cauterization of the tissue, including delayed healing and prolonged drainage. Although one may expect excision or curettage of the cauterized tissue after phenolization to benefit the healing process, these simple procedures have not been suitably studied. OBJECTIVE To examine the effect of curettage primarily on cicatrization or healing time and secondarily on postoperative bleeding. MATERIALS AND METHODS Fifty-one patients (80 feet) with stage I or IIa onychocryptosis according to the classification of Mozena were enrolled in this randomized, double-blind, parallel-group, controlled clinical trial. A total of 137 phenolizations were performed on affected folds of ingrowing hallux nails. Each hallux was randomly assigned to one of two groups (experimental [phenolization with curettage]; control [phenolization alone]). RESULTS Curettage reduced healing time (7.49 ± 1.76 days vs 12.38 ± 3.01 days; p = .001), increased postoperative bleeding (p < .001), led to lower rates of infection (p = .01), and increased postoperative pain (p = .028). CONCLUSION Curettage of the cauterized tissue after segmental phenolization reduces healing time.
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Peyvandi H, Robati RM, Yegane RA, Hajinasrollah E, Toossi P, Peyvandi AA, Ourang ZB, Shams A. Comparison of two surgical methods (Winograd and sleeve method) in the treatment of ingrown toenail. Dermatol Surg 2011; 37:331-5. [PMID: 21324043 DOI: 10.1111/j.1524-4725.2011.01880.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ingrowing toenail is one of the most common nail complaints. Although many surgical treatments are described for complicated nails, frequent recurrence of pain and postoperative disability necessitate finding an appropriate treatment. METHODS In a clinical trial, we compared the Winograd and sleeve (gutter) surgical methods to find a simple, painless, and practical alternative. RESULTS Of 100 patients (mean 27.8) included in the study, 50 underwent Winograd surgery and the rest the sleeve method. Postoperative infection occurred in four (8%) patients in the sleeve and three (6%) in the Winograd group. The condition reoccurred in five (10%) patients who underwent sleeve surgery and six (12%) who underwent Winograd. Recurrence rate was higher in female patients, although the difference was not statistically significant. Mean surgery duration for Winograd and sleeve methods was 15.7 minutes and 9.4 minutes, respectively, and postoperative work day loss was 2.0 weeks and 1.1 weeks, respectively. CONCLUSION The sleeve method seems to be more practical and appropriate for patients planning to go back to work sooner and better fulfills the main characteristics for the primary treatment of choice. The authors have indicated no significant interest with commercial supporters.
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Affiliation(s)
- Hassan Peyvandi
- Department of Surgery, Shahid Beheshti University of Medical Sciences, Shohada-e Tajrish Hospital, Tehran, Iran
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Imai A, Takayama K, Satoh T, Katoh T, Yokozeki H. Ingrown nails and pachyonychia of the great toes impair lower limb functions: improvement of limb dysfunction by medical foot care. Int J Dermatol 2011; 50:215-20. [PMID: 21244391 DOI: 10.1111/j.1365-4632.2010.04697.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Painful feet and lower limb dysfunction are risk factors for falling. Toenail deformities are common disorders in elderly people, but the relationship between nail deformities and lower limb function remains unclear. The aims of the present study were to assess the impairment of lower limb function in patients with deformities of the great toe and to determine whether foot care treatment is beneficial in reducing the risk of falling. METHODS Functional tests of the lower extremities were performed in 263 adults, including patients with any of hallux valgus, ingrown nail, or pachyonychia, and volunteers. Fifty-five subjects with nail disorders of the great toe received medical foot care treatment. RESULTS The presence of ingrown nail, pachyonychia, or tenderness of the great toe was significantly correlated with impaired postural performance and reduced muscular strength as assessed by functional tests. Medical foot care markedly reduced pain levels in the great toe and improved scores on functional tests of the lower extremities. CONCLUSIONS Toenail disorders of the great toe cause dysfunction of the lower extremities and are likely to increase the risk of falling in daily life. Foot care management of toenail disorders has the potential to improve functional abilities in daily life, particularly in elderly individuals.
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Affiliation(s)
- Akiko Imai
- Department of Dermatology, Tokyo Medical and Dental University, Tokyo, Japan.
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Cordoba Diaz D, Losa Iglesias M, Cordoba Diaz M, Becerro de Bengoa Vallejo R. Evidence of the efficacy of alcohol lavage in the phenolization treatment of ingrown toenails. J Eur Acad Dermatol Venereol 2010; 25:794-8. [DOI: 10.1111/j.1468-3083.2010.03864.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hassel JC, Hassel AJ, Löser C. Phenol chemical matricectomy is less painful, with shorter recovery times but higher recurrence rates, than surgical matricectomy: a patient's view. Dermatol Surg 2010; 36:1294-9. [PMID: 20573174 DOI: 10.1111/j.1524-4725.2010.01625.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ingrown toenails have a tendency for recurrence. Operative interventions can be successful, and several procedures are in use. OBJECTIVE Retrospective evaluation, to reveal differences in postoperative pain, time to recovery, and satisfaction with the cosmetic outcome in patients treated with a phenol (PCM) or surgical matricectomy (SM). MATERIALS & METHODS All matricectomy patients at the Dermatology Department of the Ludwigshafen City Hospital between 2004 and 2008 were interviewed over the telephone. Of 72 evaluable patients with a total of 112 ingrown nail sides, 33 were treated with PCM and 39 with SM. The patient group consisted of 40.3% women, the median age was 31. RESULTS Patients after PCM indicated two points less postoperative pain on an analogue scale from 0 to 10 (p<.001). In the PCM group, more patients recovered from the operation in less than 1 week (p=.007). Patient evaluation of cosmetic outcome was not different between the groups (p=.76), but recurrence rates were significantly higher in the PCM group (31.5%, vs 6.9% in the SM group, p=.006) CONCLUSION Both matricectomies have advantages and disadvantages. We should discuss these issues with our patients to help them decide on the kind of matricectomy.
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Affiliation(s)
- Jessica C Hassel
- Department of Dermatology, Ludwigshafen City Hospital, Ludwigshafen, Germany.
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Becerro de Bengoa Vallejo R, Losa Iglesias ME, Alou Cervera L, Sevillano Fernández D, Prieto Prieto J. Total nail ablation for onychodystrophy with optimized gauze-phenol application. J Eur Acad Dermatol Venereol 2010; 24:936-42. [PMID: 20180894 DOI: 10.1111/j.1468-3083.2010.03569.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nail disorders are frequent among the geriatric population and unfortunately, repeat avulsion procedures often result in complications. OBJECTIVE To utilize a phenol-based total matricectomy technique for permanent nail ablation and evaluate its effectiveness. METHODS We performed total nail ablation on 34 toenails of the hallux (30 patients) with a gauze-phenol application technique and evaluated the degree of pain reported by the patient 12 months postoperatively compared with the preoperative stage. Furthermore, we evaluated the patients' satisfaction with the final cosmetic appearance as well as their satisfaction with the overall procedure. RESULTS All patients reported 'too much' or 'severe' pain prior to surgery and 94.11% reported 'no pain' 12 months post-surgery. A vast majority of the patients (82.35%) felt pleased with the cosmetic results and all patients reported that they were 'very satisfied' or 'strongly satisfied' with the procedure when interviewed at their 12 month follow-up examination. LIMITATIONS There were a limited number of participants in this study across an extensive timeframe. CONCLUSION Phenol-based total nail ablation with specific gauze application is safe, inexpensive and has a high rate of patient satisfaction.
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Affiliation(s)
- R Becerro de Bengoa Vallejo
- Escuela Universitaria de Enfermería, Fisioterapia y Podología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Di Chiacchio N, Belda W, Di Chiacchio NG, Kezam Gabriel FV, de Farias DC. Nail matrix phenolization for treatment of ingrowing nail: technique report and recurrence rate of 267 surgeries. Dermatol Surg 2010; 36:534-7. [PMID: 20187894 DOI: 10.1111/j.1524-4725.2010.01490.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Nilton Di Chiacchio
- Clinic of Dermatology, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil.
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Aksoy B, Aksoy HM, Civas E, Oc B, Atakan N. Lateral Foldplasty with or without Partial Matricectomy for the Management of Ingrown Toenails. Dermatol Surg 2009; 35:462-8. [DOI: 10.1111/j.1524-4725.2009.01067.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Darwish FM, Haddad W, Ammari F, Aoudat Z. Association of abnormal foot angles and onychocryptosis. Foot (Edinb) 2008; 18:198-201. [PMID: 20307437 DOI: 10.1016/j.foot.2008.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 05/17/2008] [Accepted: 05/19/2008] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To find if there is any association between the abnormal interphalangeal (IPA) and/or hallux valgus angles (HVA) and onychocryptosis. MATERIALS AND METHODS Eighty consecutive patients with proven ingrowing toenail of all grades had their interphalangeal and hallux valgus angles of the great toe been measured on a stress view standing radiograph, and compared with a control group of normal people. RESULTS The mean age (SD) of our patients was 20 (6.4) years. Males are affected more than females. Lateral edge ingrowing was found in 85% of patients. The percentage of abnormal HVA in the diseased toes (60%), was significantly higher than that in contralateral toes (30%) (p<0.0005) and in normal controls (12%) (p<0.0005). Similarly, the percentage of abnormal IPA in the diseased toes (85%) was significantly higher than that in the contralateral toes (50%) (p<0.0005) and in normal controls (25%) (p<0.0005). CONCLUSIONS Abnormal interphalangeal and hallux valgus angles or lateral deviation of the distal phalanx significantly associated with onychcryptosis.
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Affiliation(s)
- Fayeq M Darwish
- Department of Orthopedics, Jordan University of Science and Technology, Irbid, Jordan.
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Yabe T, Takahashi M. A minimally invasive surgical approach for ingrown toenails: partial germinal matrix excision using operative microscope. J Plast Reconstr Aesthet Surg 2008; 63:170-3. [PMID: 19028446 DOI: 10.1016/j.bjps.2008.08.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 08/21/2008] [Accepted: 08/27/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND There are various methods for surgical treatment of ingrown toenails. The aim of surgery is to remove the partial germinal matrix completely, but with minimal invasiveness. In previously reported methods, the surgical procedures have been invasive, and it is uncertain whether the partial germinal matrix is completely removed. OBJECTIVE A new, less-invasive surgical approach--partial germinal matrix excision using operative microscope--is reported. METHODS Seventy-seven lesions of 56 ingrown toenails in 46 patients were treated with this method. Under an operative microscope, the germinal matrix was excised completely, but with minimal invasiveness. RESULT No cases of recurrence or spicule formation occurred, and the time required for wound healing was about 2 weeks. CONCLUSION This method is less-invasive compared with traditional methods and is effective for the treatment of ingrown toenails. This method could be an alternative treatment technique.
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Affiliation(s)
- Tetsuji Yabe
- Department of Plastic and Reconstructive Surgery, Ishikiri-Seiki Hospital, 18-28 Yayoi-Cho, Higashi-Osaka City, Osaka 579-8026, Japan.
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Partial Matrix Excision or Orthonyxia for Ingrowing Toenails. J Am Coll Surg 2008; 206:148-53. [DOI: 10.1016/j.jamcollsurg.2007.06.296] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 05/08/2007] [Accepted: 06/19/2007] [Indexed: 11/18/2022]
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Bos AMC, van Tilburg MWA, van Sorge AA, Klinkenbijl JHG. Randomized clinical trial of surgical technique and local antibiotics for ingrowing toenail. Br J Surg 2007; 94:292-6. [PMID: 17318803 DOI: 10.1002/bjs.5691] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to investigate different surgical techniques for treating ingrowing toenails (IGTNs) and to determine the value of a locally applied antibiotic after intervention. METHODS One hundred and twenty-three patients with IGTN were assigned randomly to one of four groups. All patients had partial nail avulsion. This was combined with excision of the matrix or application of phenol, with or without local application of gentamicin afterwards. All procedures were performed by one physician. The primary outcome measure was symptomatic recurrence of IGTN. RESULTS One hundred and seventeen patients were available for follow-up. Phenol gave significantly better results than matrix excision with respect to recurrence (including regrowth and spike formation) after 1 year (P < 0.001). In terms of signs of infection, there was no significant difference between phenol and matrix excision after 2 days (P = 0.224) or 1 week (P = 0.501). Antibiotics had no effect in reducing the risk of infection after 2 days (P = 0.989) or 1 week (P = 0.676), or in reducing the rate of recurrent IGTN at 1 year (P = 0.187). If regrowth or spike formation is included, the effect is even less significant (P = 0.876). CONCLUSION Partial nail avulsion with phenolization gave better results than partial avulsion with matrix excision. Local antibiotics did not reduce signs of infection or recurrence. Use of phenol did not produce more signs of infection than matrix excision.
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Affiliation(s)
- A M C Bos
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
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Lau YS, Yeung JMC. Surgical treatment of in-growing toenails performed by senior house officers: are they good enough? Scott Med J 2005; 50:22-3. [PMID: 15792384 DOI: 10.1177/003693300505000109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although the surgical treatment of in-growing toenails is a common procedure, the success of ingrown toenail surgery is extremely variable and recurrences frequently impair the quality of lift of those who have this condition. In most hospitals this procedure is commonly performed by junior surgical trainees who may have little experience. AIM We proposed to find out if the success of this procedure is operator-dependent by comparing the results of standard of toenail surgery performed by basic surgical trainees (BSTs) in our hospitals with already published data. METHODS A retrospective analysis of nail bed ablation surgery performed by BSTs under local anaesthesia over a 15-month period in a district general hospital was conducted. RESULTS 106 phenol ablations and 46 germinal matrix excisions were prformed. Symptomatic recurrence rates 12 months following the procedure were 5.7% for phenol ablation and 4.3% for germinal matrix excisions. CONCLUSION Our results are comparable to published data, and we conclude that toenail ablation surgery can be just as successfully performed by junior surgeons after relatively little training in the procedure.
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Affiliation(s)
- Y S Lau
- Department of General Surgery, Victoria Infirmary, Glasgow.
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Wedge resection with segmental phenolization in the treatment of ingrowing toenails. A better outcome. Ir J Med Sci 2005. [DOI: 10.1007/bf03170199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Islam S, Lin EM, Drongowski R, Teitelbaum DH, Coran AG, Geiger JD, Hirschl RB. The effect of phenol on ingrown toenail excision in children. J Pediatr Surg 2005; 40:290-2. [PMID: 15868600 DOI: 10.1016/j.jpedsurg.2004.09.051] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Ingrown toenails in children are a common problem with a high recurrence rate. The objective of this retrospective data review was to compare simple excision of the nail matrix with excision plus phenol (EPP) application in the treatment of ingrown toenails. METHODS The charts of 69 children who underwent surgical treatment of one or more ingrown toenails from 1994 to 2000 were reviewed. The primary procedure was noted (excision alone [EA] vs EPP) and dates of recurrences and reoperations were recorded. Parents were then surveyed by phone regarding complications, cosmetic outcome, and overall satisfaction with the procedure. Five scale categories, ranging from "strongly agree" to "strongly disagree", were used, with responses of "strongly agree" and "agree" considered as a good outcome. Either Student's t test or the chi2 test (P < .05 considered significant) was used for analysis. RESULTS Thirty-one patients (45%) were in the EPP group whereas the remaining 38 had EA. Mean length of follow-up was 4.3 years for the EA group and 2.1 years for the EPP group. There was no difference in age at operation or length of follow-up between the 2 groups. Boys were predominant in both groups. The survey response rate was 50/69 (73%). The recurrence rate of ingrown toenails in the EA group was 42% vs 4% in the EPP group (P = .003). There were no significant differences in parental response with regard to operative experience (P = .31) and the cosmetic result (P = .13), with most of the respondents (78%) indicating a good outcome for both questions. CONCLUSIONS The addition of phenol to the surgical excision of ingrown toenail significantly reduced the incidence of recurrence, with similar patient satisfaction and an equivalent cosmetic result.
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Affiliation(s)
- Saleem Islam
- CS Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI 48109, USA
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Andreassi A, Grimaldi L, D'Aniello C, Pianigiani E, Bilenchi R. Segmental phenolization for the treatment of ingrowing toenails: a review of 6 years experience. J DERMATOL TREAT 2004; 15:179-81. [PMID: 15204151 DOI: 10.1080/09546630410026860] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Ingrowing toenails are a common problem causing significant morbidity. Many of the procedures used for treating this painful condition cause considerable discomfort and have high failure rates. In recent years, phenol cauterization of the nail bed has been used increasingly. METHODS A retrospective study was carried out of all patients treated by this method in the authors' clinic during the period January 1996 to December 2001. In this study, phenol cauterization is the standard form of treatment and 948 phenol cauterizations were carried out in 764 patients. RESULTS There was no significant morbidity and the procedure was tolerated well by all patients. Overall recurrence was 4.3% (33 patients) after 18 months. All symptomatic recurrences were successfully treated by repeating phenol cauterization. CONCLUSIONS Phenol cauterization compares favourably with other surgical ablation techniques for ingrowing toenails and may be the ablation procedure of choice of an ingrowing toenail.
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Affiliation(s)
- A Andreassi
- Department of Dermatology, ASL 8, Arezzo, Italy.
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Abstract
Nail changes occur frequently in adults, but are relatively rare in children. There are, however, certain nail changes that emerge particularly during childhood. Ingrown nails, onychoschizia, congenital slanted alignment of the large toenail, and psoriasiform nail dystrophies can be frequently observed in toddlers and in schoolchildren the syndrome of an ingrown nail, nail artifacts, periungual warts or fibromas, trachyonychia, and nail mycoses. Connatal nail changes can appear as isolated events or together with other symptoms whereas acquired nail changes are caused by infections, traumatic injuries, or tumors, in conjunction with skin diseases or general illnesses, or even develop spontaneously.
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Affiliation(s)
- I Effendy
- HautklinikStädtische Kliniken Bielefeld.
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