Long-term results of nail correction with double wires for pincer nail deformity: A retrospective cohort study

There is no consensus on the best treatment for pincer nail deformity. We developed a novel procedure that uses double wires to treat pincer nail deformity on the great toe. This study aimed to describe this technique for pincer nail deformity treatment and present the long-term findings/observations. After injecting a local anesthetic, a mini router was used to make holes on both sides of the nail plate edge, and the wire was inserted in two places, one proximal and the other distal to the great toenail. The wire was removed when it moved to the tip of the great toe as the nail grew. Patients who underwent this method were evaluated retrospectively from 2014 to 2020. Patients with less than 24 months of follow-up were excluded. If pain occurred again, it was deemed as a recurrence. A total of 27 patients (36 toes, mean age: 69.5 years) were evaluated. In all cases, the pain disappeared 1 week after the procedure. In the correction period (mean 2.7 months), six toes had complications (nail break, four toes and nail hold pain, two toes), while recurrence occurred in four toes within 2 years. Curvature (nail tip height/width of nail tip × 100%) improved significantly up to 1-year post-procedure (37.7 ± 14.4%, p < 0.05) as compared to pre-correction (53.8 ± 24.7%). The procedure time was short (approximately 10 minutes), and the treatment was completed with a single procedure. In addition, the recurrence rate was low.

Management of Pincer Nail Deformity by Realignment of Nailbed Using a Dermofascial Graft

Pincer nail deformity is an uncommon entity which can be painful and cosmetically unappealing. We describe our technique of correcting this deformity by realignment of the nailbed using a dermofascial graft. Pain relief as well as a cosmetically good result have been obtained in all patients, and this has been maintained over the long term. The technique has proven to be safe, effective, and reproducible.

Soft Tissue Chondroma: A Possible Diagnosis of Single-Digit Nail Clubbing

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Onychogryphosis

BACKGROUND

Onychogryphosis is a nail disorder that can damage nail plates, usually caused by repeated minor trauma to the foot. Onychogryphosis of the toe is commonly seen in clinical practice; however, optimal treatment of the condition is still the subject of debate. The purpose of this study was to evaluate clinical outcomes of patients with toe onychogryphosis treated by subcutaneous flap coverage after total matricectomy.

METHODS

In this article, we describe 12 patients who had onychogryphosis on the great toe treated by subcutaneous flap coverage after total matricectomy. There were eight men and four women, with a mean age of 63.8 years (range, 56-74 years).

RESULTS

The follow-up period ranged from 4 to 108 months, with an average of 25.2 months. All of the flap reconstructions ultimately survived.

CONCLUSIONS

The advantage of the described technique is the avoidance of tight closure of the skin and preservation of toe length. The possible limitation of the technique is poor blood circulation to the feet.

A new surgical technique for the correction of pincer nail deformity

BACKGROUND

Pincer nail is a rare deformity characterized by transverse overcurvature of the nail that increases distally. Many conservative and surgical treatment modalities have been recommended, but there is not a worldwide accepted technique for long lasting treatment of this deformity yet.

PURPOSE

A new surgical technique for the treatment of pincer nail deformity is described.

MATERIAL AND METHOD

In this procedure, after the osteophyte located on the dorsal surface of the distal phalanx is removed to provide a flat surface for the nail bed, the distal part of the nail bed is enlarged in a transverse direction by using a modified 5-flap z-plasty technique. Over 2 years, this technique has been performed on 15 toes in 8 patients.

RESULTS

In all patients, the deformity was eliminated successfully with no recurrence in 2 years of follow up. The growing nail turned back into its natural form and all clinical signs and symptoms of the pincer nail deformity were relieved.

CONCLUSIONS

Widening and flattening the nail bed provide a longlasting effective treatment of the pincer nail deformity with an excellent esthetic result. Pain and episodes of infection is relieved perfectly with this new technique.

Pincer nail: aesthetic concept in surgery

Although pincer nail deformity (PND) treatment is time consuming independent of whether it is based on surgical or conservative procedures, long lasting beneficial results are found only after surgical intervention. Typically destruction of the lateral matrix horns either surgically or by phenol cauterization or even ablation of the matrix is performed. In the past these procedures mainly aimed at relief from pain; however, currently more patients ask for the preservation of the nail unit and a good cosmetic outcome. Today reconstructive results that meet the patient expectations are available. An adapted novel surgical method which will preserve the matrix horns while correcting the shape of the phalanx and preventing renewed adhesion of the nail bed to the phalanx is presented. Therefore the restoration of a normal width-to-length ratio of the nail plate with a cosmetically appealing result becomes possible. Surgical steps in an affected right toenail are presented.

Does a bone deformity of the distal phalanx undergo remodeling after removal of a congenital ectopic nail?: A case with periodic radiographic follow-up

BACKGROUND

Congenital ectopic nails are rare and are characterized by the presence of nail-like tissue mainly at the tip of a finger or toe.

OBJECTIVE

Although the accompanying bone deformity might undergo remodeling after removal of the ectopic nail, it remains unknown whether complete bone remodeling can be eventually achieved, and whether such remodeling is necessary to improve the final cosmetic appearance of the concerned fingertip.

METHODS AND RESULTS

Follow-up with periodic radiographic examination for 1 year after surgery in a child with congenital ectopic nail revealed no bone remodeling, despite the satisfactory cosmetic result.

CONCLUSION

We conclude that residual bone deformity does not affect the final appearance.

Treatment of transverse overcurvature of the nail with a plastic device: measurement of response

BACKGROUND

Transverse overcurvature of the nail is a painful condition that has been treated by conservative and/or surgical methods.

OBJECTIVES

We sought to evaluate the efficacy of a plastic device for treatment of transverse overcurvature of the nail and to use a practical method (plaster mold) to evaluate follow-up of nail widening during and after treatment.

METHODS

Twenty-five patients with transverse overcurvature of the nail were treated with placement of a plastic device. Pain assessment was done on a monthly basis. Nail improvement was evaluated through photographs and measurement of widening by plaster molds.

RESULTS

Relief of pain could be determined in almost 100% of the cases in a 3-month period. Widening of overcurvature of the nail occurred in all cases. The plaster mold allowed a practical measurement of improvement in nail shape.

CONCLUSION

The plastic device is an effective, safe, noninvasive, and inexpensive treatment option for overcurved nails. The plaster mold is a practical method to evaluate improvement in nail shape.

En Bloc Excision of Proximal Nail Fold for Treatment of Chronic Paronychia

BACKGROUND

Chronic paronychia is a very recalcitrant dermatosis, which is particularly prevalent in housewives. Medical treatment for this condition is unsatisfactory in a significant number of cases. Surgical approach forms an important part of management, however, this area has received little attention. Various surgical approaches have been tried in the past but a comparative analysis has not been attempted.

OBJECTIVES

The present study aims at assessing the efficacy of en bloc excision of proximal nail fold (PNF). Moreover, a comparative analysis has been undertaken to assess whether or not simultaneous nail plate avulsion improves the treatment outcome.

METHODS

Thirty patients of chronic paronychia with nail plate irregularities were randomly divided into two treatment groups (15 patients each). After a detailed evaluation, en bloc excision of PNF with or without nail plate removal was performed. Postoperative measures were advised and the patients were kept under regular follow-up thereafter. Assessment of postoperative complications was also performed.

RESULTS

Twelve patients in group I and 13 patients in group II completed the treatment protocol. Of these, 70% of patients were cured in group II (en bloc excision with nail avulsion) whereas only 41% were cured in group I (en bloc excision without nail avulsion).

CONCLUSION

En bloc excision of the PNF is a useful method in recalcitrant chronic paronychia. Simultaneous avulsion of the nail plate improves the surgical outcome. Strict avoidance of irritant exposure is necessary to ensure complete treatment and prevent recurrence.

Pincer Nail Deformity Associated with Systemic Lupus Erythematosus

BACKGROUND

Systemic lupus erythematosus (SLE) is an autoimmune disorder with various systemic and cutaneous manifestations. Nail abnormalities, including onycholysis, red lunulae, pitting, and ridging, have been seen in patients with the disorder. To our knowledge, however, pincer nail deformity has yet to be reported coincident with the onset of SLE.

OBJECTIVE

We report a case of pincer nail deformity subsequent to the development of SLE and describe surgical treatment of the deformed nails. This is followed by a review of the literature.

CONCLUSION

Acquired pincer nail is a dystrophy with numerous reported causative associations, including psoriasis, tumors of the nail apparatus, tinea ungium, ss-blocker usage, and now SLE. Pain from the resulting constriction can interfere greatly with daily activities and can be debilitating to the extent of requiring therapy.

A splint for pincer nail surgery: a convenient splinting device made of an aspiration tube

BACKGROUND

To treat pincer nail, both conservative therapy and surgical therapy have been reported. However, there is no consensus about the best method of treatment.

OBJECTIVE

The use of a splint prepared from an aspiration tube after pincer nail surgery is introduced.

METHODS

Pincer nail was treated by surgery with splinting in seven patients (nine toes).

RESULTS

Nine toes from seven patients were evaluated. The postoperative follow-up period ranged from 6 to 37 months (mean 17.7 months). An excellent result was obtained in eight toes, but ingrowth of the nail occurred in one toe. The cosmetic improvement was marked and satisfactory.

CONCLUSION

This splint is cheap and easy to make, can prevent contracture of the nail matrix and nail bed, can reduce pain, and allows direct observation of the nail bed because it is transparent. Thus, this technique seems to be convenient and useful.

Correction of pincer-nail deformities with autograft or homograft dermis: modified surgical technique

The pincer-nail deformity is characterized by an excessively curved and distorted nail across the transverse dimension. Forty-nine sides (paronychial folds) were dissected off the distal phalanx periosteum with scissors and/or a small elevator. The dermis was placed between the paronychial fold and the plalanx to flatten the germinal and sterile matrix. Direct comparison of autograft dermis to homograft dermis did not show any significant differences in postcorrection appearance of the nail or relief of symptoms. Surgical time averaged 22 minutes less in those patients having reconstruction on both sides of one nail with homograft dermis.

Reconstruction of the great toe ski-slope, sunken-nail deformity with a buried adipofascial flap

Development of a ski-slope deformity following loss of the great toe nail plate is a problematic condition with few conservative or surgical options available. The condition becomes more difficult to treat when the distal, medial, and lateral labial nail folds are hypertrophied, creating the appearance of a sunken nail. We present a case of ski-slope, sunken-nail deformity following multiple attempts at chemical nail matrixectomy. The patient's persistent pain and deformity were managed through 1) nail plate avulsion and complete surgical excision of the germinal nail matrix, 2) remodeling of the distal phalanx, and 3) elevation of an adipofascial flap from the plantar tuft of the great toe, which was brought from plantar to dorsal and interposed between the dorsal aspect of the distal phalanx and the overlying nail bed in buried fashion. The combination of these procedures elevated the nail bed, which restored normal architecture to the great toe and relieved the pain associated with the chronic deformity. This case demonstrates a potential complication of a commonly performed procedure and a salvage technique useful for dealing with the resultant ski-slope, sunken-nail deformity.

Treatment of severe deformities of the toenails by the modified Zadik method with artificial skin

A number of operations have been devised to treat ingrowing toenails and pincer nails, and they have given good aesthetic and functional results. However, there have been few reports of operations for the treatment of severe nail deformities caused by damage to the matrix of the nail by injury, or by inappropriate removal of the nail or intractable onychomycosis or cardiovascular or neurological disorders. In 1950, Zadik reported a radical technique for ingrown nails and pincer nails: after avulsion of the nail, the matrix was excised completely and the posterior nail wall was sutured to the nail bed as an advancement flap. We have treated 23 severe deformities other than ingrown nails and pincer nails in 14 patients by the modified Zadik method with artificial skin. As a result, symptoms including pain were alleviated in all patients. The nail plate did not regenerate, and no patient had aesthetic complaints.

[Use of a bilobed flap for the treatment of mucous cysts]

INTRODUCTION

In the case of mucous cysts with attenuated skin, the authors suggest radical excision of the cyst together with the overlying skin. The skin defect is repaired with a bilobed flap whose donor site is left to heal by secondary intention. This surgical procedure also allows exploration of other areas of mucoid degeneration and repair of the proximal nail fold when necessary.

METHOD

Twenty-six patients with an average age of 59 years (27 cysts), were operated with this procedure. Nail bed deformities were present in 55% of the cases. The cyst and the overlying skin were radically excised in conjunction with a dorsal capsulectomy; the use of the bilobed flap made the dissection easier, and flap translation allowed cover of the capsulectomy area and simultaneous repair of the nail fold in eight cases.

RESULTS

Patients were reviewed with an average follow-up of 13.7 months. Seventy percent of the patients had no pain, and in 85% of the cases there was no loss of motion. Cosmetic appearance was satisfactory, and nail bed deformities disappeared or clearly subsided in 86% of the cases. One patient developed recurrence.

DISCUSSION

Many surgical procedures have been described for mucous cysts treatment. This simple procedure allows radical excision of the cyst and the attenuated skin with low risk for the germinal matrix, precise location of cyst origin, repair of the nail fold and good skin cover in the capsulectomy area.

Inherited accessory nail of the fifth toe cured by surgical matricectomy

BACKGROUND

The inherited accessory nail of the fifth toe is a common condition in the Chinese population.

OBJECTIVE

The objective was to demonstrate three lesions in two cases of inherited accessory nail of the fifth toe successfully treated with surgical matricectomy.

METHODS

Under local anesthesia and use of tourniquet, the proximal nail fold was incised and the matrix of the accessory nail was exposed and then excised by scalpel surgery. The skin defect left after removal of the lesion was repaired with a rotation flap.

RESULTS

Histopathologic examination of the surgical specimens revealed that the matrices of the accessory nails were completely extirpated. No recurrence was found 2 years after operation.

CONCLUSION

The inherited accessory nail of the fifth toe was cured by surgical matricectomy.

Avulsion and partial matricectomy with the carbon dioxide laser for pincer nail deformity

BACKGROUND

Pincer nail deformity is a common nail disorder that sometimes necessitates surgical intervention. A multitude of therapeutic modalities has been implemented to treat this condition.

OBJECTIVE

To describe the use of the carbon dioxide laser in the successful treatment of pincer nail deformity.

METHODS

This is a case report and literature review.

RESULTS

A 63-year-old man was evaluated and treated with the carbon dioxide laser for a persistent pincer nail deformity. The patient tolerated the procedure well and had an acceptable surgical outcome.

CONCLUSION

Pincer nail deformity may be successfully treated with the carbon dioxide laser, especially when a partial matricectomy is performed.

Onychauxic dystrophic toenails requiring debridement in Medicare patients. Prevalence and anatomical distribution

Six hundred twenty-nine Medicare patients were evaluated for the presence of onychauxic toenails that in the judgment of the examiners required reduction. Forty-two percent of this group had five or fewer toenails requiring reduction and 24.3% had six or more toenails requiring reduction. Statistics reported by a regional Medicare-contracted carrier for the years 1997 to 1999 showed that 95% of claims submitted for nail debridement were for six or more nails and 5% were for five or fewer nails. The 1999 Medicare Part B data listed the top 300 Current Procedural Terminology (CPT) foot-care codes in order of utilization. Code 11721 (debridement of six or more nails) was number one. National statistics from the Health Care Financing Administration in 1999 indicated approximately a 5:1 ratio in favor of CPT code 11721 (six or more nails). In contrast, this study found a ratio of 2:1 in favor of CPT code 11720 (five or fewer nails).

Nail regeneration by elongation of the partially destroyed nail bed

Patients with partially destroyed fingernails tend to hide them, and such patients often do not find help because fingernails are considered of little functional value. To improve the aesthetic appearance of such nails, a simple excision of the destroyed nail matrix can stimulate the growth of the residual healthy matrix and regenerate the nail. Prerequisite is a healthy nail residue of at least the lunula. An excision of an en bloc, crescent-shaped, full-thickness scar, 5 mm at its greatest width and extending from one lateral nail fold to the other, increases the length of the nail plate. Together with the matrix, the nail will grow about 4 mm distally. A second crescent-shaped excision 1 to 2 months later will further lengthen the nail until it has gained full length. Normal nail growth was achieved in 11 patients who had partially scarred nail beds after mycosis or trauma.

Perionychial grafts in trauma and reconstruction

With careful attention to anatomic repair and by replacing missing tissue with similar tissue, corrections in emergency situations can be accomplished with predictably good results. Even in the most complex of injuries, normal nails are the expectation rather than the surprise endpoint of surgical repair. Improved results in the treatment of chronic nail deformities encourage a bolder surgical stance when patients present with nail deformities. Although more work needs to be done in the field of total nail replacement, a well-performed full-thickness composite graft in carefully selected and prepared patients may be an appropriate solution to a problem that has been ignored too often.

Free vascularized nail grafts for onychogryphosis of bilateral thumbnails after burn injury

Free vascularized grafts of the toenails were used to repair bilateral onychogryphosis occurring after burn injury.

Onychogryphosis in elderly persons: an indicator of long-standing poor nursing care? Report of one case and review of the literature

A 92-year-old immobilized white woman under the daily nursing care of a private ambulatory nursing service displayed acquired deformities of the toenails resembling a ram's horn. In light of a rapidly growing elderly population, this case report illustrates the need for close monitoring of the quality of care that nursing services provide to older persons. In addition, it reviews the clinical aspects of onychogryphosis, as well as its pathomechanisms and treatment options.

The bifid great toe: a surgical approach

The surgical treatment of bifid great toes has not generated as much interest as that of its upper extremity counterpart. Early treatment of this foot deformity is necessary for ease of shoe wear and cosmesis. Five feet surgically corrected by a variation of the Bilhaut-Cloquet procedure were followed up for 4 years. Because of postoperative nail bed deformities, the nail splitting incision of Bilhaut-Cloquet should be avoided.

Pincer nails: definition and surgical treatment

BACKGROUND

There are four main types of ingrown nail. These are distal nail embedding, juvenile (subcutaneous) ingrown nail, hypertrophy of the lateral nail fold (lip), and pincer nail.

OBJECTIVE

The etiology of pincer nail may be hereditary or acquired. The mechanism of the most common form, an enlarged base of the distal bony phalanx, is discussed.

METHODS

Use of roentgenogram and magnetic resonance imaging highlights exophytes of the base and dorsal hyperostosis of the distal phalanx.

RESULTS

Global assessment may lead in mild cases to medical therapy. Usually, however, the lateral matrix horn must be surgically removed or cauterized by phenol. Dermal grafting under the nail matrix provides excellent long-term results.

Pincer nails: a new surgical treatment

BACKGROUND

Pincer nails are a kind of nail deformity characterized by a transverse overcurvature of the nail that increases along the longitudinal axis. Alteration of the shape of the underlying distal phalanx due to osteophyte formation at the apex may be a cause of pincer nails. This causes widening of the proximal matrix and as a result secondary torque in the distal nail plate leading to the typical appearance. Apart from conservative treatment, several surgical techniques have been proposed in the past.

METHODS

This article presents a new surgical approach in the treatment of recalcitrant pincer nails which has several distinct advantages over other methods.

RESULTS

Long-term results in six patients are presented.

A new surgical therapeutic approach to pincer nail deformity

BACKGROUND

Pincer nail deformity (PND) is an important health problem that causes discomfort in daily life. Until now, some surgical and conservative treatment modalities were applied with success. However, there is still no consensus on the common and accepted form of treatment.

OBJECTIVE

To present a new surgical therapeutic approach to PND.

METHODS

Ten patients, four with bilateral and six with unilateral PND, were treated with a new surgical technique which is a combination of chemical matricectomy with phenol and nail bed repair.

RESULTS

No recurrence was observed in any of the patients after 12-16 months follow-up. No serious complication was encountered. The cosmetic improvement was also marked and satisfactory.

CONCLUSION

This new surgical approach was found to be effective and is presented as an alternative treatment modality for PND.

Correction of crooked nail deformity by modified osteoplastic reconstruction

To correct crooked nail deformity, which results from the partial loss of the distal phalanx, soft-tissue restoration alone is usually not enough to restore the length and shape of the nail structure. The authors treated 10 crooked nail fingertips by modified osteoplastic reconstruction, which included the elevation of the dorsally based volar skin flap and an iliac bone graft covered by an adequate skin flap. During the postoperative follow-up, the nail straightened, although not to the preinjury extent, along the restored distal phalanx with bony support. The authors' osteoplastic reconstruction, which involves the enhancement of the fingertips with composite tissues, presents a practical method for the correction of crooked nail deformity.

Correction of pincer-nail deformity using dermal grafting

Pincer-nail syndrome has been described as distortion in the shape of the nails with excessive transverse curvature of the plate that increases from proximal to distal, leading to pinching and loss of soft tissue in the affected digit, resulting in severe pain. Many treatments have been recommended, but an effective long-term method that preserves the nail matrix has not been described. A method of dermal grafting under the nail matrix is described, and the results of treatment of six digits are reported. Five women and one man with an average age of 52 were treated. The affected digit was the thumb in four patients and the great toe in two patients. Follow-up averaged 25 1/2 months. The results were good in all cases with only one side of one nail remaining slightly curved. Pain was relieved in all cases, and complete adherence of the new nail plate occurred. Dermal grafting seems to provide excellent long-term treatment of the pincer-nail deformity with preservation of the nail matrix.

A case report of Atasoy antenna procedure

A 25-year-old man presented with hook nail and painful atrophic pulp over the tip of the terminal phalanx of the right thumb 3 months following a crush injury. Lateral nail folds were poorly defined and the nail was curved. The patient was unable to pick up objects with a precision pinch. Reconstruction was performed with Atasoy antenna procedure. One year later, normal pulp contour of the injured thumb was restored and appearance of the nail was normal.

[Palmar and dorsal nail anlage of the small finger. A case report]

A congenital malformation of a 18-month-old boy is presented. Palmar and dorsal surface of the small finger presented a complete nail. Active flexion of the PIP and DIP joints was not possible. The small finger displayed typical dorsal skin both dorsally and palmarly. Flexion creases were absent. The palmar nail was removed, and the defect was covered by a cross-finger flap.

Etiology and treatment of nail malalignment

BACKGROUND

There are three main types of nail malalignment. These are: congenital nail malalignment of the big toenail, traumatic nail malalignment, and iatrogenic malalignment of the nail plate.

OBJECTIVE

Treatment is only of benefit in the first two conditions, and specific surgical approach to each condition is outlined. The probable mechanism of iatrogenic malalignment is discussed.

RESULTS

Nail rotation for congenital malalignment produces its best results in early childhood.

CONCLUSION

Surgery is of benefit in congenital malalignment and traumatic malalignment and is worthwhile in selected cases. Iatrogenic malalignment that is the consequence of wide lateral nail biopsies or similar excisions does not respond to treatment.

Nail transfer: evolution of the reconstructive procedure

Reconstruction of a missing or deficient nail is an interesting and challenging undertaking for plastic surgeons, but little has been published concerning this topic. In the past 23 years, from 1973 to 1995, we performed 24 operations for nail reconstruction in 19 patients. A free nail graft was used in 14 operations, and a vascularized nail flap was used in 10. Vascularized nail flaps were divided into three categories: long-pedicle vascularized nail flaps (3 nails), vascularized nail flaps supplied by arterial inflow from the venous system (termed venous flaps, 3 nails), and short-pedicle vascularized nail flaps (4 nails). In only one case of free nail graft did the grafted nail necrose secondary to infection. The other 23 nails (13 free nail grafts, 10 vascularized nail flaps) survived completely, and good nail growth was obtained. With progress in plastic surgery, reconstructive procedures for nails have changed. In this paper, we will report the evolution of our reconstructive procedure and current strategy of nail reconstruction.

Enchondroma of the distal phalanx of the hand

We saw five patients who had enchondroma of the distal phalanx, a relatively uncommon site for that lesion. Three patients had pain secondary to a pathological fracture and were managed with curettage and bone-grafting through a palmar longitudinal incision. The other two patients had severe deformities of the fingertip and nail. One was managed with disarticulation of the distal interphalangeal joint and the other, with curettage and grafting through a dorsal approach followed by reconstruction of the nail matrix. We believe that the palmar incision in the pulp of the finger has few, if any, complications.