Chemical matricectomy with 10% sodium hydroxide for the treatment of ingrown toenails in people with diabetes

Management of ingrowing nail

For decades, there has been debate about the cause of ingrown nail: is the nail plate or the periungual tissue at fault? There is no consensus and management relies on case-by-case analysis followed by tailored treatment. Conservative treatment should be attempted in children when the cause is transient (e.g., poor clipping) or the patient refuses surgery. Surgical treatments rely on two main approaches: either narrowing the nail plate, or debulking the soft tissue. It is up to the surgeon to select the most appropriate approach in each case. All procedures discussed in this chapter have high cure rates as long as they are properly performed. As with all surgical procedures, they are operator-dependent. Chemical cautery is the easiest and most versatile technique that may help in almost all instances for lateral ingrowth. For distal ingrowth and very hypertrophic and exuberant lateral folds, debulking with primary or secondary healing is most effective.

A fast and effective solution for ingrown toenail: Creation of a 2-mm space between tissue and nail by sutureless lateral longitudinal excision

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).

Chemical matricectomy with sodium hydroxide: long-term follow-up results

BACKGROUND

Chemical matricectomy with sodium hydroxide is a method being used successfully in the treatment of ingrown toenail.

OBJECTIVE

In this study, it was aimed to evaluate long-term recurrence rates after chemical matricectomy using sodium hydroxide application of different durations.

MATERIALS AND METHODS

Two hundred two patients with ingrown nail edges were treated with either 1-minute (Group 1) or 2-minute (Group 2) applications of sodium hydroxide matricectomy. All patients were followed for at least 2 years.

RESULTS

Chemical matricectomy with sodium hydroxide was applied to a total of 585 nail edges of 202 cases. The overall recurrence rates in Group 1 and Group 2 were 6.4% and 7.1%, respectively, during the average 7.5-year follow-up period. No statistically significant differences were detected in terms of recurrence between the 2 groups (p = .73).

CONCLUSION

Chemical matricectomy with sodium hydroxide is an easy method in the treatment of ingrown nails, with low morbidity and high success rates. There was no difference between 1-minute and 2-minute applications in terms of recurrence during the long-term follow-up. Chemical matricectomy with 1-minute application of sodium hydroxide showed high success in terms of long-term follow-up results.

Partial matricectomy with curettage and electrocautery: a comparison of two surgical methods in the treatment of ingrown toenails

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.

Exploring postoperative outcomes for ingrown toenails. NaOH vs wedge resection techniques

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.

Controversies in the treatment of ingrown nails

Ingrown toenails are one of the most frequent nail disorders of young persons. They may negatively influence daily activities, cause discomfort and pain. Since more than 1000 years, many different treatments have been proposed. Today, conservative and surgical methods are available, which, when carried out with expertise, are able to cure the disease. Packing, taping, gutter treatment, and nail braces are options for relatively mild cases whereas surgery is exclusively done by physicians. Phenolisation of the lateral matrix horn is now the safest, simplest, and most commonly performed method with the lowest recurrence rate. Wedge excisions can no longer be recommended.