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Huang S, Wang J, Chen Z, Kang Y. Surgical interventions for ingrown toenail. Foot Ankle Surg 2024; 30:181-190. [PMID: 38177051 DOI: 10.1016/j.fas.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/04/2023] [Accepted: 12/17/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Paronychia is a prevalent clinical disease affecting the soft tissue surrounding the nails. Most cases of toenail paronychia are commonly associated with ingrown toenails. While conservative treatment is effective for mild cases of ingrown toenails, surgical intervention becomes necessary for moderate to severe cases, particularly when granulomas form. OBJECTIVE To provide a systematic understanding of these classic and modified procedures for surgeons to select the appropriate surgical interventions for patients suffering from moderate to severe ingrown toenails and discuss this technology's advantages and limitations for dermatologic surgery. METHODS A literature search was performed using PubMed/MEDLINE and Google Scholar databases. Studies discussing surgical intervention for ingrown toenails were included. Moreover, the surgical steps were meticulously depicted by detailed schematic diagrams. RESULTS These surgical techniques can be divided into three categories: matrix resection, debulking of periungual soft tissues, and the rotational flap technique. Each approach possesses distinct advantages and limitations. CONCLUSION For moderate to severe cases, surgical interventions may exhibit superior outcomes, faster recovery times, and lower recurrence rates. The surgeon must possess a comprehensive understanding and proficient skillset in various surgical techniques for ingrown toenails.
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Affiliation(s)
- Shan Huang
- Department of Oncology, People's Hospital of Huangpi District, Jianghan University, Wuhan 430300, China
| | - Jiaojiao Wang
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zhenbing Chen
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yu Kang
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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Sargin S, Gulcu A, Aslan A. Does the Type of Surgical Technique and the Use of Prophylactic Antibiotics Affect the Clinical Results in Symptomatic Ingrown Toenail Patients? INT J LOW EXTR WOUND 2024; 23:124-132. [PMID: 34515568 DOI: 10.1177/15347346211043602] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Serdar Sargin
- School of Medicine, Balıkesir University, Balıkesir, Turkey
| | - Anil Gulcu
- School of Medicine, Alanya Alaaddin Keykubat University, Alanya, Turkey
| | - Ahmet Aslan
- School of Medicine, Alanya Alaaddin Keykubat University, Alanya, Turkey
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Hassan RE, Khan L, Shah SH, Naeem H, Noor N, Iqbal M, Dawood Khan F, Rehman Z, Ahmad W, Tanveer S, Khan AU, Shah SH. Surgical Strategies for Ingrown Toenails: A Comprehensive Review of Techniques, Outcomes, and Advancements. Cureus 2024; 16:e52501. [PMID: 38371148 PMCID: PMC10874229 DOI: 10.7759/cureus.52501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Ingrown toenail (IGTN), known as onychocryptosis or unguis incarnatus, is a painful condition affecting the big toe, with symptoms including pain, inflammation, and infection. This review explores surgical options for IGTN, categorized into altering the nail plate or diminishing periungual tissues. Conservative treatments alleviate early-stage symptoms, while surgical interventions are reserved for severe cases. Various surgical techniques are discussed, such as the Winograd technique, Vandenbos procedure, chemical matricectomy, radiofrequency ablation, bipolar diathermy, carbon dioxide laser ablation, Zadik's procedure, Howard-Dubois procedure, Super U procedure, Noël's procedure, knot technique, and toenail paronychium flap. The choice of procedure depends on the severity and recurrence of IGTN.
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Affiliation(s)
- Rao E Hassan
- Orthopaedics and Trauma, Khyber Teaching Hospital Medical Teaching Institute (MTI), Peshawar, PAK
| | - Luqman Khan
- Orthopaedics and Trauma, Khyber Teaching Hospital Medical Teaching Institute (MTI), Peshawar, PAK
| | | | - Hamid Naeem
- Cardiac Surgery, Rehman Medical Institute, Peshawar, PAK
| | - Nazish Noor
- Dermatology, Lady Reading Hospital Medical Teaching Institute (MTI), Peshawar, PAK
| | - Momina Iqbal
- Surgery, Ayub Teaching Hospital, Abbottabad, PAK
| | | | - Zahir Rehman
- Surgery, Ayub Teaching Hospital, Abbottabad, PAK
| | - Waheed Ahmad
- General Surgery, Hayatabad Medical Complex Medical Teaching Institute (MTI), Peshawar, PAK
| | - Shafiq Tanveer
- Ophthalmology, Khyber Teaching Hospital Medical Teaching Institute (MTI), Peshawar, PAK
| | | | - Syed Hassnain Shah
- Orthopaedics and Trauma, Pakistan Institute of Medical Sciences, Islamabad, PAK
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Dąbrowski M, Rusek D, Dańczak-Pazdrowska A, Litowińska A. The Influence of Clinical Factors on Treatment Outcome and a Recurrence of Surgically Removed Protruded Subungual Osteochondroma and Subungual Exostosis. J Clin Med 2023; 12:6413. [PMID: 37835058 PMCID: PMC10573305 DOI: 10.3390/jcm12196413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/25/2023] [Accepted: 10/08/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Subungual exostosis (SE) and subungual osteochondroma (SO) are benign solitary lesions that grow from the distal phalanx. The mass itself is typically painless, but pressure on the nail plate can result in pain and deformity of the involved digit. Tumors can be correctly diagnosed based on clinical, histological and radiographic appearance alone. Surgical resection of SE/SO is typically curative, with a small risk of recurrence. METHODS The study was retrospective and observational, involving 74 patients with subungual SE/SO. The surgical procedure consisted of the removal of the tumor from the dorsal approach under digital anesthesia. The procedure was assessed using a questionnaire and photo documentation after a minimum of 6 months after surgery. RESULTS A total of 85% of respondents were satisfied with the procedure. Nearly 80% of patients rated the cosmetic effect as good or very good. Young age and pain intensity after surgery showed statistically significant associations with worse satisfaction. Age < 18 was associated with recurrence. CONCLUSIONS Worse satisfaction is strongly associated with recurrence. Gender, duration of symptoms, pain before surgery and tumor size and destruction of the nail plate had no significant effect on recurrence. The technique using burr appeared to be a more effective treatment.
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Affiliation(s)
- Mikołaj Dąbrowski
- Adult Spine Orthopaedics Department, Poznan University of Medical Sciences, 61-545 Poznan, Poland
- Anmedica-Healthy Foot Center, Grunwaldzka Street 121, 60-313 Poznan, Poland;
| | - Damian Rusek
- Department of Pathomorphology, Regional Hospital in Poznań, Juraszów 7 St., 60-479 Poznan, Poland;
| | | | - Anna Litowińska
- Anmedica-Healthy Foot Center, Grunwaldzka Street 121, 60-313 Poznan, Poland;
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Kim J, Lee S, Lee JS, Won SH, Chun DI, Yi Y, Cho J. A Minimally-Invasive, Simple, Rapid, and Effective Surgical Technique for the Treatment of Ingrown Toenails: A Reminder of the Original Winograd Procedure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18010278. [PMID: 33401516 PMCID: PMC7794890 DOI: 10.3390/ijerph18010278] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 12/25/2020] [Accepted: 12/29/2020] [Indexed: 11/20/2022]
Abstract
(1) Background: Ingrown toenail is a common disorder of the toe that induces severe toe pain and limits daily activities. The Winograd method, the most widely used operative modality for ingrown toenails, has been modified over years to include wedge resection of the nail fold and complete ablation of the germinal matrix. We evaluated the outcomes of original Winograd procedure without wedge resection with electrocautery-aided matrixectomy. (2) Methods: We retrospectively analyzed the outcomes of patients who underwent surgery for ingrown toenails at a university hospital for two years from November 2015 to October 2017. Surgery was performed in 76 feet with a mean operation time of 9.34 min. (3) Results: The minimal interval from surgery to return to regular activities was 13.26 (range 7 to 22) days. Recurrence and postoperative wound infections were found in 3 (3.95%) and 2 (2.63%) patients, respectively. Evaluation of patient satisfaction at one-year follow-up showed that 40 (52.63%) patients were very satisfied, 33 (43.42%) were satisfied, 3 (3.95%) were dissatisfied, and none of them were very dissatisfied. The average follow-up duration was 14.66 (range 12 to 25) months. (4) Conclusions: Therefore, it is believed that this less-invasive and simple procedure could be easily performed by clinicians, with satisfactory patient outcomes.
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Affiliation(s)
- Jahyung Kim
- Department of Orthopedic Surgery, Seoul Hospital, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea
| | - Sanghyeon Lee
- Department of Orthopaedic Surgery, Ewha Womans University Seoul Hospital, Seoul 07804, Korea
| | - Jeong Seok Lee
- Department of Orthopedic Surgery, Seoul Hospital, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea
| | - Sung Hun Won
- Department of Orthopedic Surgery, Seoul Hospital, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea
| | - Dong Il Chun
- Department of Orthopedic Surgery, Seoul Hospital, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea
| | - Young Yi
- Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul 04551, Korea
| | - Jaeho Cho
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University, Gangwon-do 24253, Korea
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