Nail surgery

Current Topics in Nail Surgery

Background:

Nail surgery can be performed in an office-based dermatology practice with a limited amount of specialized equipment and training. Several excellent reviews have been published in recent years that detail the techniques of nail surgery for both the novice and the experienced practitioner.

Objective:

In this article recent developments in nail surgery are discussed. Topics that are treated include the general principles of nail surgery, including epidemiologic issues, studies of nail anatomy, instrumentation, and anesthesia. The reconstruction of injuries and congenital defects involving the nail is explained, and the role of the hand surgeon clarified. Appropriate removal of tumours and cysts is considered, with special attention to the management of malignant lesions. The controversy regarding more or less conservative management of melanonychia striata is addressed, and the need for early diagnosis of subungual melanoma is emphasized. Other topics are surgical management of ingrown nails and onychomycosis. Newer areas of nail surgery, such as laser surgery of the nail, psycho-dermatology of the nail, and the role of primary care physicians in simple nail surgery are also examined.

Total nail ablation for onychodystrophy with optimized gauze-phenol application

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.

Comparison of phenol and sodium hydroxide chemical matricectomies for the treatment of ingrowing toenails

OBJECTIVE

Chemical matricectomy is performed mainly by two agents: phenol and sodium hydroxide. Both agents have excellent cure rates, but there are no data about the comparison of postoperative healing periods. This study was designed to compare the postoperative morbidity rates of sodium hydroxide and phenol matricectomies.

MATERIALS AND METHODS

Forty-six patients with 154 ingrowing nail sides were treated with either sodium hydroxide or phenol matricectomy. In the postoperative period, the patients were evaluated for the duration and severity of pain, drainage, and peripheral tissue destruction; complete healing periods; and overall success rates.

RESULTS

The incidence of pain was higher in the sodium hydroxide group on the first visit, on the second day, but all patients became pain-free after that. The incidence and duration of drainage and peripheral tissue destruction was significantly higher in the phenol group. The mean period for complete recovery was 10.8 days in the sodium hydroxide group, whereas it was 18.02 days in the phenol group. The overall success rates in the sodium hydroxide and phenol groups were found to be 95.1 and 95.8%, respectively.

CONCLUSION

Both sodium hydroxide and phenol are effective agents giving high success rates, but sodium hydroxide causes less postoperative morbidity and provides faster recovery.

Minimizing postoperative drainage with 20% ferric chloride after chemical matricectomy with phenol

BACKGROUND

Phenol used in partial matricectomy shows its effects by denaturing matrix proteins. This highly successful method has the major problem of oozing which can continue for 5-6 weeks.

OBJECTIVE

The goal of this study was to determine the effect of 20% ferric chloride (FC) (FeCl3) on minimizing the oozing after chemical matricectomy with phenol.

METHODS

Sixty-seven patients with stage III onychocryptosis were treated by chemical matricectomy with 90% aqueous phenol. In 32 of these patients FC was applied to the nail bed after the phenolization procedure.

RESULTS

We found a statistically significant (P <.001) reduction of oozing in the FC-applied group of patients.

CONCLUSION

We think that using FC after phenol chemical matricectomy results in a significant reduction in oozing from the operation site.