Ingrown toenails: an evaluation of elevating the nail bed-periosteal flap

Surgical interventions for ingrown toenail

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.

Clinical Evidence for the Relationship between Nail Configuration and Mechanical Forces

Summary:

Mechanobiology is an emerging field of science that focuses on the way physical forces and changes in cell or tissue mechanics contribute to development, physiology, and disease. As nails are always exposed to physical stimulation, mechanical forces may have a particularly pronounced effect on nail configuration and could be involved in the development of nail deformities. However, the role of mechanobiology in nail configuration and deformities has rarely been assessed. This review describes what is currently understood regarding the effect of mechanical force on nail configuration and deformities. On the basis of these observations, we hypothesize that nails have an automatic curvature function that allows them to adapt to the daily upward mechanical forces. Under normal conditions, the upward daily mechanical force and the automatic curvature force are well balanced. However, an imbalance between these 2 forces may cause nail deformation. For example, pincer nails may be caused by the absence of upward mechanical forces or a genetic propensity increase in the automatic curvature force, whereas koilonychias may occur when the upward mechanical force exceeds the automatic curvature force, thereby causing the nail to curve outward. This hypothesis is a new concept that could aid the development of innovative methods to prevent and treat nail deformities.

A new surgical technique for ingrown toenail

Background. Ingrowing toenails are a common condition which, when recurrent and painful, are often treated surgically. The aim of this study is to present a new simple surgical technique for ingrown toenails with good results. Method and Patients. The selected 250 patients with affected toes were surgically treated by our technique and observed from 1998 to 2004. Marginal nail elevation combined with surgical excision of the granulation tissue was more successful. For fixing the nail margin on the toe we have done one-bite suture by Nylon 3/0 that was removed after 3 weeks. Results. All patients were operated on by our new technique and the outcome was excellent; recurrence and failure of the technique were very low. Discussion. Because with this simple technique we excise the granulation tissue and elevate margin of nail over the skin, we will have higher cure rate, shorter postoperative pain, lower risk of postoperative infection, and remarkable cosmetic result without deformity; hence this technique should be considered as an alternative method of treatment.

Clinical comparison of the scanning CO2 laser and conventional surgery in the treatment of ingrown nail deformities

AIM

To compare statistically the clinical effects and postoperative course of the scanning CO(2) laser and conventional surgical method to evaluate the clinical effectiveness of the former for the treatment of ingrown nail deformities.

METHODS

We performed vaporization of the nail matrix using the scanning CO(2) laser in 25 cases with ingrown nail deformities.

RESULTS

In 21 cases, the recurrence of ingrown nail deformity was not observed during follow-up. All cases were free of postoperative infection. Use of the scanning CO(2) laser reduced postoperative pain, and all patients were able to return to their daily activities by day 3 post-surgery without any problems.

CONCLUSIONS

Statistically, the operating time and the duration of postoperative pain were reduced significantly by the scanning CO(2) laser. Furthermore, patients treated with CO(2) laser were able to return to daily life significantly sooner.

Onychocryptosis

Onychocryptosis is prevalent globally and most often the result of self-attempts at curing the condition in its earliest stages. Its clinical presentation is often confused with a number of osseous and soft tissue abnormalities, some of which have great import to a patient's overall welfare. Treatment consists of local and systemic care, including nail avulsion. Recurrences are reduced when some form of matricectomy is used. Matricectomy techniques vary and must be selected on the basis of caregiver and patient preference. Although the chemical matricectomy is popular, care must be exercised in selecting patients for its use.

Radical surgery for ingrown nails by partial resection of the nail plate and matrix using a carbon dioxide laser

BACKGROUND

We report here on the successful surgical treatment of ingrown nails by partial resection of the nail plate and matrix using a carbon dioxide laser.

MATERIALS AND METHODS

The subjects of this study were 28 patients (37 cases) who visited our outpatient clinic with the chief complaint of ingrown nails of the great toe between October 1995 and October 1999. They included 12 males and 25 females. Patient age ranged from six to 72 years (mean 26.5 years), and the post operative follow-up period ranged from eight to 48 months (mean 23.2 months).

RESULTS

Clinically, this treatment was excellent in terms of operating time reduction, mitigation of mid-operative and post-operative bleeding and pain, and treatment period reduction. Furthermore, no recurrences were observed during the study period.

CONCLUSIONS

Judging from the good therapeutic results and improved quality of life of patients, this treatment is expected to be commonly used in the future.

Ingrown nails: a comparison of the nail matrix phenolization method with the elevation of the nail bed-periosteal flap procedure

Seventy-five procedures were performed on 62 patients with ingrown nails from 1992 to 1996. Those consisted of 51 nail matrix phenolization methods (NMP) and 24 elevation of the nail bed-periosteal flap procedures (ENF). Ingrown nails were classified into type A (normal nail plate) and type B (incurved nail plate). The duration and intensity of postoperative pain were assessed, and the recurrence rate was monitered. The recurrence rate was 3.9% in the NMP group and 4.1% in the ENF group. Concerning the recurrence rate, there was no statistical significance between ENF and NMP in both types. Postoperative pain intensity was less in the NMP group than in the ENF group in both types (P < 0.01). The same tendency was seen in postoperative pain duration. However, the NMP group had longer duration of wound healing compared with the ENF group in type A (P < 0.01). We conclude that NMP is a recommendable treatment for most ingrown nails.