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The Modified versus the Conventional Winograd Technique for the Treatment of Onychocryptosis: A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137818. [PMID: 35805476 PMCID: PMC9266244 DOI: 10.3390/ijerph19137818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 12/10/2022]
Abstract
The Winograd technique is a common surgical treatment for ingrown toenails. Attempting to improve the results of this technique, two modifications were adopted: the incisional approach and the use of adhesive approximation strips. This study aimed to compare the conventional technique and the modified version based on (i) postoperative complications, (ii) healing time, (iii) recurrence rate, and (iv) overall patient satisfaction. A longitudinal, observational, and retrospective design was used, with a sample of 208 patients divided into the modified Winograd technique (n = 111) and the conventional Winograd technique (n = 97) in three clinics in Portugal, with follow-up periods of more than 15 years and 10 years, respectively. The modifications to the Winograd technique revealed fewer postsurgical complications, in terms of infections (1.8% vs. 20.62%, p < 0.010), recurrence rate (2.7% vs. 5.21%, p > 0.05), shorter recovery time (8.10 ± 0.76 vs. 14.51 ± 3.48 days, p < 0.001), and lower postoperative pain and better satisfaction with the functional and esthetic results, with the patient’s overall satisfaction, and with significant differences in relation to the conventional technique (p < 0.001). The modifications performed showed a lower rate of infection, decreased healing time, and better patient satisfaction, suggesting that it may be adopted in clinical practice for the treatment of stages II and III ingrown toenails.
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Oliveira F, Izquierdo Cases JO, Silva Santos A, Ramos S, Lafuente Sotillos G. A new modification of the Winograd technique for the treatment of ingrown toenail. REVISTA ESPAÑOLA DE PODOLOGÍA 2022. [DOI: 10.20986/revesppod.2022.1634/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Kim BS, Kim K, Day J, Seilern Und Aspang J, Kim J. Ultrasound-Guided Popliteal Nerve Block with Short-Acting Lidocaine in the Surgical Treatment of Ingrown Toenails. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105059. [PMID: 34064708 PMCID: PMC8151049 DOI: 10.3390/ijerph18105059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 11/16/2022]
Abstract
Background: Digital nerve block (DB) is a commonly utilized anesthetic procedure in ingrown toenail surgery. However, severe procedure-related pain has been reported. Although the popliteal sciatic nerve block (PB) is widely accepted in foot and ankle surgery, its use in ingrown toenail surgery has not been reported. Therefore, this study aimed to investigate the safety and effectiveness of PB in the surgical treatment of ingrown toenails. Methods: One-hundred-ten patients surgically treated for an ingrown toenail were enrolled. Sixty-six patients underwent DB, and 44 underwent PB. PB was performed under ultrasound-guidance via a 22-gauge needle with 15 mL of 1% lidocaine in the popliteal region. The visual analogue scale was used to assess pain at two-time points: pain with skin penetration and pain with the solution injection. Time to sensory block, duration of sensory block, need for additional injections, and adverse events were recorded. Results: PB group demonstrated significantly lower procedure-related pain than the DB group. Time to sensory block was significantly longer in the PB group (20.8 ± 4.6 versus 6.5 ± 1.6 minutes). The sensory block duration was significantly longer in the PB group (187.9 ± 22.0 versus 106.5 ± 19.1 minutes). Additional injections were required in 16 (24.2%) DB cases, while no additional injections were required in PB cases. Four adverse events occurred in the DB group and two in the PB group. Conclusion: PB was a less painful anesthetic procedure associated with a longer sensory block duration and fewer repeat injections compared with DB. The result of this study implicates that PB can be an alternative anesthetic option in the surgical treatment of ingrown toenails.
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Affiliation(s)
- Beom Suk Kim
- Uijeongbu Eulji Medical Center, Department of Physical Medicine and Rehabilitation, Eulji University, Daejeon 11759, Korea;
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul 02841, Korea
| | - Kyungho Kim
- Department of Orthopedic Surgery, Armed Forces Daejeon Hospital, Daejeon 34059, Korea;
- Samsung Medical Center, Department of Orthopedic Surgery, Seoul 06351, Korea
| | - Jonathan Day
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA; (J.D.); (J.S.U.A.)
- School of Medicine, Georgetown University, Washington, DC 20007, USA
| | - Jesse Seilern Und Aspang
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA; (J.D.); (J.S.U.A.)
- Department of Orthopedic Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Jaeyoung Kim
- Department of Orthopedic Surgery, Armed Forces Daejeon Hospital, Daejeon 34059, Korea;
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA; (J.D.); (J.S.U.A.)
- Correspondence:
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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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Turan Ç, Şahin T, Meral Ekşioğlu H. How effective is cryotherapy applied to the nail fold in ingrown toenails? ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2020. [DOI: 10.15570/actaapa.2020.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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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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Camurcu Y, Sofu H, Issin A, Kockara N, Saygili H. Operative Treatment of the Ingrown Toenail With a Less-Invasive Technique: Flashback to the Original Winograd Technique. Foot Ankle Spec 2018; 11:138-141. [PMID: 28587478 DOI: 10.1177/1938640017713615] [Citation(s) in RCA: 6] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the results of the partial nail plate excision and curettage of nail bed and matrix (the original Winograd technique) in patients with ingrown toenail. MATERIALS AND METHODS Patients with ingrown toenail who were treated surgically from May 2014 to June 2015, with a minimum follow-up of 1 year were included in this study. Those who had previous ingrown toenail surgery were excluded. Partial nail plate excision with curettage of nail bed and nail matrix was performed for all patients. Rifampicin soaked sterile gauze was placed onto the wounds after the procedure. RESULTS The study population included 100 males and 89 females with a mean age of 30 years. Eight patients (4.2%) had stage 1, 71 patients (37.6%) had stage 2, and 110 patients (58.2%) had stage 3 ingrown toenails. The mean operation time was 4.8 minutes. No complication occurred during the procedure. It was found that 15 patients (7.9%) had recurrence during the follow-up. CONCLUSION The original Winograd technique is an efficient and less-invasive technique for the treatment of ingrown toenail, with lower rates of recurrence and complications. LEVELS OF EVIDENCE Therapeutic Case Series Study, Level IV.
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Affiliation(s)
- Yalkin Camurcu
- Department of Orthopaedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, Turkey (YC, HS, AI, NK)
- Department of Orthopaedics and Traumatology, Kozan State Hospital, Adana, Turkey (HS)
| | - Hakan Sofu
- Department of Orthopaedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, Turkey (YC, HS, AI, NK)
- Department of Orthopaedics and Traumatology, Kozan State Hospital, Adana, Turkey (HS)
| | - Ahmet Issin
- Department of Orthopaedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, Turkey (YC, HS, AI, NK)
- Department of Orthopaedics and Traumatology, Kozan State Hospital, Adana, Turkey (HS)
| | - Nizamettin Kockara
- Department of Orthopaedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, Turkey (YC, HS, AI, NK)
- Department of Orthopaedics and Traumatology, Kozan State Hospital, Adana, Turkey (HS)
| | - Hakan Saygili
- Department of Orthopaedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, Turkey (YC, HS, AI, NK)
- Department of Orthopaedics and Traumatology, Kozan State Hospital, Adana, Turkey (HS)
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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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A new and simple suturing technique applied after surgery to correct ingrown toenails may improve clinical outcomes: A randomized controlled trial. Int J Surg 2016; 34:1-5. [DOI: 10.1016/j.ijsu.2016.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 07/22/2016] [Accepted: 08/04/2016] [Indexed: 11/21/2022]
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Espada Vega C, Martínez Nova A. Eficacia de las técnicas quirúrgicas más utilizadas en el tratamiento de la onicocriptosis: una revisión sistemática. REVISTA ESPAÑOLA DE PODOLOGÍA 2016. [DOI: 10.1016/j.repod.2016.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] 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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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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Affiliation(s)
- Bertrand Richert
- Dermatology Department; Université Libre de Bruxelles, University Hospital Brugmann - Saint Pierre - Children Hospital Queen Fabiola; Brussels; Belgium
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