Conservative treatment of ingrowing toenails

A combination of conservative measures was used to treat 105 patients with 119 ingrowing toenails. The method proved to be simple and cheap, but time consuming. Post-treatment discomfort and the time taken to return to normal activities were acceptable; the cosmetic result was good. Two-year follow-up revealed that the success rate of the method in less advanced cases (stages I and II) was high (96 per cent), although in the long term there was a tendency to recurrence in stage II cases. The failure rate in advanced cases (stage III) was high (up to 62 per cent). Conservative treatment can be used successfully in mild cases of ingrowing toenails.     

The surgical treatment of ingrowing toenails

Two prospective studies of ingrowing toenail management were conducted. In the first, 163 patients (204 ingrowing nail edges) who had not had previous surgery were randomised and treated by total nail avulsion, nail edge excision, or nail edge excision with phenolisation of the germinal matrix; recurrence rates one year postoperatively were 73%, 73% and 9% respectively. In the second study, 63 ingrowing nail edges which had recurred after previous operations underwent nail edge excision and phenolisation. There was a 5% recurrence rate and 5% incidence of dystrophy of the nail one year after operation.     

Partial matrix excision or orthonyxia for ingrowing toenails

BACKGROUND: We wanted to evaluate whether partial matrix excision and orthonyxia are equally effective in the treatment of ingrown toenails of the hallux. STUDY DESIGN: We conducted a prospective randomized clinical trial with 12-month observer-blinded followup, in the surgical outpatient department of a teaching hospital. We randomized 105 consecutive patients with a total of 109 ingrown toenails to either partial matrix excision (n=58) or an orthonyxia procedure (n=51). The main outcomes measurements were rate of recurrence after 12 months, postoperative morbidity, and time to complete recovery. RESULTS: The 12-month followup was completed in 55 of 58 patients undergoing partial matrix excision and 47 of 51 patients having orthonyxia. There were four ingrown toenails, four recurrences in the partial matrix excision group, and eight in the orthonyxia group (NS, p=0.14). Postoperative morbidity parameters (redness, pus, postoperative bleeding); time to complete recovery, wearing shoes (p < 0.01), and performing activities of daily living and hobbies; postoperative symptoms; and patient satisfaction all favored orthonyxia. CONCLUSIONS: Partial matrix excision and orthonyxia are equally effective treatments for ingrown toenails. But the orthonyxia procedure showed better results, with less postoperative morbidity, shorter time to complete recovery, fewer postoperative symptoms, and greater patient satisfaction.     

Partial matrix excision or segmental phenolization for ingrowing toenails

OBJECTIVE: To decide whether partial nail extraction with phenolisation or with partial excision of the matrix should be the standard treatment in patients with ingrowing toenails of the hallux. DESIGN: Randomized clinical trial with 12-month follow-up evaluations performed by observers who did not know which procedure was applied. SETTING: Outpatient department of a surgical teaching hospital. PATIENTS: Fifty-eight consecutive patients with a total of 63 ingrowing toenails were randomized. INTERVENTION: Thirty-four partial matrix excisions ("matrix" group) and 29 phenolizations ("phenol" group) were performed. MAIN OUTCOME MEASURES: Recurrence rate, postoperative morbidity (pain, wound exudates, and scar discomfort), and time to complete recovery (wearing shoes, performing normal activities/work). RESULTS: Recurrences were seen after 7 procedures in the matrix group and also after 7 procedures in the phenol group, of which patients were symptomatic and required a second operation in 4 and 3 instances, respectively. None of the observed differences in wound healing, postoperative pain, and recovery were statistically significant. CONCLUSIONS: Partial matrix excision and phenolization are equally effective in treating ingrowing toenails. Because the use of the toxic agent phenol should be avoided, partial matrix excision is the preferable procedure. But in view of the high recurrence rate, there is a need for further improvement of the treatment of ingrowing toenails.     

Randomized, prospective study of nail bed ablation for recurrent ingrowing toenails

A consecutive series of 31 recurrent ingrowing toenails, which had previously undergone at least two surgical procedures, were recruited to this study over a 1-year period. Patients were randomly allocated to one of two treatment groups. Group A underwent nail bed excision whilst group B had nail bed phenolization in addition to excision. Patients were reviewed 2 weeks and 1 year after operation. Seven toes (41%) in group A developed postoperative infection compared with only one (7%) in group B (P less than 0.01). Recurrent nail spicules occurred in ten patients (59%) in group A and six patients (43%) in group B 1 year after operation. High failure rates for ablation of recurrent ingrowing toenails should encourage greater efforts towards adequate treatment at the first presentation.     

Segmental phenolization of ingrowing toenails: a randomized controlled study

One hundred and three patients, on whom 107 procedures for ingrowing toenails were performed, were randomly allocated into one of two treatment groups: segmental or angular phenolization and wedge excision. There were 53 wedge excisions and 54 segmental phenolizations. Post-treatment discomfort was assessed on a linear analogue scale of 10 cm. There was no difference between the two groups one week after treatment. Over a mean follow-up period of 14 months a total of 20 nail spikes occurred, 4 in the phenolized group and 16 in the wedge excision group, this being a significant difference at the one per cent level.     

Approach to ingrowing toenails: the wedge resection/segmental phenolization combination treatment

One hundred and seventy procedures were performed on one hundred and forty patients with ingrowing toenails. Each patient was randomly allocated to one of three treatment groups. There were 55 wedge resections (WR), 53 segmental phenolizations (SP) and 62 wedge resection/segmental phenolization combination treatments (WR/SP). All patients were followed up for 6 months. The duration and intensity of postoperative pain was assessed and the recurrence rate monitored. Postoperative pain was less in the WR/SP group (9.4 +/- 13.5 h) than in the WR group (30.0 +/- 37.6 h, P less than 0.001). There were seven recurrences in the WR group, four in the SP group, and none in the WR/SP group. The results in the WR/SP group were statistically significant when compared with the WR group (P less than 0.01) and with the SP group (P less than 0.05). We conclude that the WR/SP combination procedure is a superior form of treatment for ingrowing toenails.     

The treatment of ingrowing toenails. A randomised comparison of wedge excision and phenol cauterisation

We treated 249 patients for ingrowing toenails in a prospective randomised study which compared wedge excision with segmental phenol cauterisation. Follow-up of 97% was at a minimum of 14 months. The analgesic requirement was significantly lower after phenol cauterisation (p less than 0.001), and significantly fewer patients needed to miss school or work (p = 0.001). Recurrence of ingrowth was seen in 16% after wedge excision and 9.6% after phenol cauterisation (not significant), but re-operation was significantly less frequent after phenol (p less than 0.01). Phenol cauterisation gives better short-term and long-term results than wedge resection.     

难复性寰枢椎脱位的外科治疗

<正>伴有临床症状的难复性寰枢椎脱位(irre-ducible atlantoaxial dislocation,IAAD)的治疗方式是实现延、脊髓的有效减压。但由于其位于颅底附近,位置较深且紧邻延髓等重要结构,特别是颈前路有较多重要神经、血管、腺体毗邻,     

低位直肠癌的外科治疗选择

直肠癌的外科治疗模式在结直肠外科工作中不断地更新,主要体现在围手术期治疗模式的转变、手术方式的涌现等方面;距肛缘5 cm以内的低位直肠癌治疗又是大家所关注的重点.本文结合近二十年来该领域的新观点,分析检查、治疗手段的优劣,合理选择手术方式,阐述低位直肠癌的诊治规范,并探讨其发展趋势.     

Surgical and nonsurgical treatments for lumbar spinal stenosis

Lumbar spinal stenosis (LSS) is the most common indication for spinal surgery in older adults; however, the efficacy of surgery for LSS as compared to nonsurgical treatments remains unclear. Here, we reviewed numerous studies, including randomized control trails (RCTs), to compare nonsurgical and surgical treatments for LSS. The nonsurgical management of LSS includes medication, epidural injections, physiotherapy, lifestyle modification, and multidisciplinary rehabilitative approaches. Patients with LSS who do not improve after nonsurgical treatments are typically treated surgically using decompressive surgery, which has the strongest evidence base. Although decompressive surgical treatment is associated with modestly successful outcomes, it remains unclear whether decompression combined with fusion surgery results in clinical outcomes that are superior to those following decompression surgery alone. Future RCTs assessing the effectiveness of specific treatments based on high-quality scientific evidence are expected to aid clinical decision-making and improve treatment outcomes for LSS.     

包皮环切术后环状瘢痕挛缩的手术治疗

目的 探讨包皮环切术后切口瘢痕挛缩的手术治疗方法.方法 2003年1月至2009年12月,我院共收治包皮环切术后出现环状瘢痕挛缩的患者共36名,年龄17～45岁,平均(28.7±8.9)岁,入院后在腰麻或阴茎背神经阻滞麻醉下接受手术治疗.根据环状瘢痕的宽度、增生及挛缩程度、现有包皮组织量,分别予以瘢痕切除后精细缝合、二次包皮环切或多个“Z”成形术治疗.分别于术后1周、6周、3个月和6个月进行随访,随访内容为:(1)伤口外形及愈合情况;(2)阴茎勃起后有无不适及束缚感,(3)性生活改善情况.结果 90.1％ (33/36)的患者术后对伤口恢复满意,术后有2例患者内板水肿仍存在,3例仍伴有勃起时不适感.结论 根据包皮环切术后环状瘢痕挛缩的程度及伴发症状,选择不同手术方式进行矫治,可有效松解环状挛缩,消除或减轻阴茎勃起后不适感,提高性生活满意度.初次术式与矫正手术后疗效有一定的关系.