部分甲体甲床甲母质切除甲沟成形术治疗嵌甲型甲沟炎256例

目的:探讨一种利用甲侧襞皮瓣改变甲体与甲沟的位置结构,从而彻底治愈嵌甲型甲沟炎的手术方法。方法:切除部分甲体、甲床及甲母质,并利用甲侧襞皮瓣成形甲床、甲沟、甲侧襞联合结构。结果:本院2010年1月～2011年6月对256例嵌甲患者,足趾255例、手指1例,共376侧嵌甲进行甲沟成形手术,随访6月～2年,取得满意效果。结论:本手术从根本上彻底解决了嵌甲的病因,手术并发症少,复发率极低。     

Ingrown toe-nail

A satisfactory operation for the cure of an ingrown toe-nail that can be performed by the average man with uniformly good result had been presented.     

改良Winograd术治疗(足母)趾嵌甲症

(足母)趾嵌甲症是外科门诊的常见病,自1994年5月～1998年10月,笔者应用改良Winograd术治疗27例（足母）趾嵌甲症,效果良好,总结如下. 1 病历资料 1.1 一般资料 本组男10例,女17例,平均年龄26(16～56)岁.平均病程3.2(2～7)年.单趾发病者16例,双趾发病者11例,共44处.Frost分型[1]:趾甲正常但甲刺或甲钩长入周围组织者24例(38处);趾甲正常甲唇肥大阻塞甲沟者2例(2处),趾甲侧缘内翻生长压迫甲沟内组织者1例(4处).并发甲沟炎者5例,合并甲癣者4例.     

Modified Sleeve Method Treatment of Ingrown Toenail

BACKGROUND: Ingrown toenail is a common problem that causes inconvenience, pain, and limitation of daily function. Current conventional treatment methods are not satisfactory and have a high recurrence rate. OBJECTIVE: To evaluate a modification of an existing, although uncommonly used, method for treating ingrown toenail. METHODS: Patients with ingrown toenail were treated under local anesthesia by insertion of a flexible narrow plastic tube under the toenail along its lateral border. Tube fixation was performed with silk or nylon 2-0 sutures passed through the toenail. Granulomatous and inflamed tissue was removed by electrocautery or local excision. RESULTS: Twenty-eight procedures were performed in 25 patients. In 20 procedures (71.4%), no recurrences were recorded; the other 8 procedures (28.6%), were symptomatic. CONCLUSION: This method for the treatment of ingrown toenail was found to be simple and efficient, with a relatively low recurrence rate. Therefore we currently advocate this procedure as the treatment of choice.     

Surgical Treatment of Ingrown Toenail without Matricectomy

BACKGROUND Partial excision of the nail matrix (matricectomy) is generally considered necessary in the surgical treatment of ingrown toenail. Recurrences may occur, however, and poor cosmetic results are frequently observed.
OBJECTIVE The objective is to present a new surgical procedure for ingrown toenail with complete preservation of the nail matrix.
METHODS Twenty-three patients with ingrown toenail were included in this study. The surgical excision was performed 1 week after the completion of treatment of the initial infection. A large volume of soft tissue surrounding the nail plate was removed under local anesthesia. No matrix excision was performed.
RESULTS Short-term results were excellent. No recurrences or severe complications were observed during the minimum 12-months follow-up period. Cosmetic results were remarkable.
CONCLUSIONS Ingrown toenail results from the compression of the lateral nail folds on the nail plate. This study shows that ingrown toenail can be surgically treated without matricectomy. A large volume of soft tissue surrounding the nail plate should be removed to decompress the nail and reduce inflammation. Cosmetic results are excellent and superior to the classical Emmert plasty. Postoperative nail dystrophies and spicule formation are not observed. The main advantage of this surgical approach is the complete preservation of the anatomy and function of the nail to improve both therapeutic and cosmetic results.     

足嵌甲的整复手术治疗研究

作为临床常见足部疾病,足嵌甲可导致足趾甲周围剧烈疼痛,同时对患者日常活动和生活造成 严重影响。目前临床治疗足嵌甲的方法较多,但对于采取何种治疗方式尚未统一,如治疗方式选取不当, 不但无法发挥理想治疗效果,而且患者治疗后易复发。因此,需根据患者疾病情况和患者实际情况采取科 学治疗方案,从而实现有效治疗。本文主要对足嵌甲症病因和分期、治疗方案的选择进行综述,以期为足 嵌甲临床治疗提供思路。     

部分拔甲治疗嵌甲效果观察

目的 观察部分拔甲术治疗嵌甲的临床效果.方法 将100例嵌甲拟行拔甲治疗的患者随机分为观察组和对照组各50例,对照组采用全甲拔除术,观察组行部分拔甲术.结果 两组治疗效果比较,差异无显著性意义(P＞0.05);两组拔甲和首次换药剧痛率比较,差异有显著性意义(P＜0.01).结论 部分拔甲术治疗嵌甲疗效好,同时可减轻患者痛苦,促进创面愈合.     

Presentation of Metastatic Carcinoma as Pedal Stress Fracture and Ingrown Toenail

Metastatic lesions localized to the foot are rare. When present, such lesions are typically associated with a poor prognosis. A good history can help guide the clinician when formulating differential diagnoses for a questionable clinical presentation. We report the case of a patient presenting with findings indicative of a metatarsal stress fracture and an ingrown toenail, which eventually resulted in the diagnosis of metastatic disease from the lung. ACFAS Level of Clinical Evidence: 4.     

Risk Factors and Frequency of Ingrown Nails in Adult Diabetic Patients

The present study evaluated the properties of nails, frequency of ingrown nails in patients with type 2 diabetes mellitus (DM), risk factors for developing ingrown nails, and effect of diabetic polyneuropathy and vasculopathy on the development and outcome of ingrown nails. Our 6-month epidemiologic prospective study included 300 patients with type 2 DM attending a DM outpatient clinic for routine examinations. The general characteristics and foot changes of the study population were investigated. Diabetic polyneuropathy and vasculopathy were evaluated using a biothesiometer, monofilament tests, and arterial Doppler ultrasonography. The frequency of ingrown nails was 13.6%. Multivariate analysis with logistic regression showed that body mass index (odds ratio [OR] 1.077, 95% confidence interval [CI] 1.007 to 1.15; p?=?.03), previous trauma (OR 2.828, 95% CI 1.017 to 7,867, p?=?.042), a weak dorsalis pedis pulse (OR 2.72, 95% CI 1.17 to 6.30, p?=?.02), trimming type (OR 2.3, 95 CI 1.06 to 4.98), p?=?.35), onychogryphosis (OR 9.036, 95% CI 2.34 to 34.87, p?=?.001), and subungual hyperkeratosis (OR 4.3, 95% CI 1.99 to 9.3, p?=?.001) were predictive variables for ingrown nails in our population. The incidence of onychomycosis was significantly greater in patients with ingrown nails (p?=?.032) than in patients without ingrown nails. The nail curvature ratio was greater in the patients with ingrown nails than in the group with normal nails. Arterial Doppler ultrasound examinations showed peripheral arterial disease in 19 patients (46.9%) with ingrown nails. The prevalence of ingrown nails was greater in the patients with DM than in the healthy population. Our results indicate that nail type, nail morphology, and diabetic vasculopathy affect the formation and evolution of ingrown nails.     

A Simple, Pain-Free Treatment for Ingrown Toenails Complicated with Granulation Tissue

BACKGROUND: The treatment of ingrown toenail complicated with granulation tissue is usually partial or total nail avulsion with or without matricectomy. It costs loss of occupational power, however, because most patients cannot go to work or school for some time after surgery, and it is a costly and uncomfortable procedure for most patients. OBJECTIVE: This study aimed to find an easy, painless, and inexpensive alternative. MATERIALS AND METHODS: Seven patients with ingrown toenails complicated with granulation tissue are included. A small apparatus was applied on the nails, granulation tissue was chemically cauterized, and a foot bath was recommended twice daily. They were followed on a weekly basis or every other week until recovery. None of the patients received systemic treatment. RESULTS: All seven patients were completely cured without requiring surgery and/or systemic treatment. The procedure did not have any effect on their daily life. The follow-up examination of the patients at 6 months revealed that they were totally cured, and there were no recurrences. CONCLUSION: Patients with ingrown toenails complicated by granulation tissue might have an inexpensive and pain-free treatment alternative, although new studies with more patients are required.     

Tumors of the nail and nail bed

This article reviews the tumors that most frequently affect the nail and nail bed. Clinical appearance, histopathology, differential diagnosis, and treatment are discussed.     

Long-Term Results of Nail Brace Application in Diabetic Patients with Ingrown Nails

BACKGROUND Ingrown toe nail is a common foot problem; however, there are limited data concerning the treatment options for diabetic patients.
OBJECTIVE Because of the special attention given to avoidance of infection and ulceration of the foot in diabetics, we applied a new, simple nail device as a treatment option without any systemic treatment or surgical intervention.
METHODS AND MATERIALS We applied braces to 21 diabetic patients with ingrown toe nails. All had severe pain, erythema, and edema without suppuration or granulation tissue formation. Braces were applied until all the symptoms are cleared. We followed the patients for 2 years for the recurrence of symptoms and signs.
RESULTS All patients had immediate relief of symptoms once the brace was applied. After the dislocation of braces, 15 of 21 patients did not have any recurrences for 2 years. Six patients had recurrence of pain and ingrown nail and were willing to use the brace once more instead of having any operations.
CONCLUSION Nail brace application is a safe, simple, and inexpensive treatment option for diabetic patients with ingrown toe nails. Although there may be recurrences, patients are willing to use it for a second time as it is simple and pain free.     

Winograd Method Versus Winograd Method With Electrocoagulation in the Treatment of Ingrown Toenails

An important component of the Winograd surgical method for an ingrown toenail is total excision of the associated germinal matrix. However, this might not always be accomplished with the procedure. We hypothesized that the surgical results might be improved by adding electrocoagulation of the germinal matrix to the Winograd method. The objective of the present study was to compare the recurrence, satisfaction, and complication rates of the Winograd method with those of the Winograd method with electrocoagulation. We retrospectively evaluated the records of 102 patients with single Heifetz stage 2 or 3 ingrown toenails who had undergone surgery from January 2013 to October 2014 using 1 of these 2 methods. Of the 102 patients, 50 (49%) underwent the Winograd method and 52 (51%) underwent the Winograd method with electrocoagulation. The mean follow-up period of our patients was 12 (range 6 to 22) months. An ingrown toenail recurred in 3 patients (6%) in the Winograd group and in no patient in the Winograd with electrocoagulation group (p = .04). Among the patients in the Winograd group, 46 (92.0%) were satisfied or very satisfied. Among the patients in the Winograd plus electrocoagulation group, 49 (94.2%) were satisfied or very satisfied (p = .04). No complications developed in either group. In conclusion, the Winograd method for ingrown toenails results in high satisfaction rates, low recurrence rates, and low complication rates. The addition of electrocoagulation of the germinal matrix to the Winograd method could result in even lower recurrence rates, while maintaining high patient satisfaction and without increasing the risk of complications.     

Half-and-half nail

Clinical and Experimental Nephrology -     

Vascularized nail flap vs. free nail graft

Summary With recent improvements in microvascular surgery, the vascularized nail flap procedure has had considerable success. On the other hand, free nail graft without microvascular anastomoses is still used but little has been published to make a comparison between these two procedures. Thus, it is not known which is the better procedure. In the past, hand nail defects in 12 patients have been reconstructed by the free nail graft procedure and in four patients by vascularized nail flap procedure. In this article, the free nail graft is compared with the vascularized nail flap and the merits and demerits of both techniques are presented. Requests for reprints: T. Endo, M.D.     

Similarities between a conjoined nail and the palmar nail syndrome

The congenital palmar nail syndrome consists of a triad of palmar nail, absent finger flexion and abnormalities of the distal phalanx. There are two main theories about the pathogenesis of this syndrome: the ancestral reversion theory and the duplication theory. In this paper, similarities between a conjoined nail in conjoined twins and the palmar nail syndrome are described to support the duplication theory.     

Common nail disorders

The toenails and the rest of the human foot are constantly sandwiched in shoes, traumatized, and poorly supplied with blood that is necessary for normal morphology and function, resulting in more abnormal changes of the toenails (onychopathies). This article discusses briefly the following: (1) the conditions that are commonly seen in feet by podiatric practitioners; (2) clinical signs, symptoms, and etiology; and (3) differential diagnosis and care of the conditions.