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.     

Nail-Splinting Technique for Ingrown Nails: The Therapeutic Effects and the Proper Removal Time of the Splint

BACKGROUND: An ingrown nail is a common disorder that occurs most frequently in the great toe and causes much discomfort in patients. Although many therapeutic methods have been described, most of them can lead to severe damage to the nail or to frequent relapses. The nail-splinting technique is known to be a noninvasive therapeutic method for treating an ingrown nail. OBJECTIVE: Our purpose was to access the recurrence rate of the nail-splinting technique and to determine the proper removal time of the splint from the ingrown nail. METHODS: Fifty-seven patients with ingrown nail were treated with the nail-splinting technique. Subjects were randomized into two groups. For group 1 (28 patients), the splint was removed splint 3 days after treatment, whereas for group 2 (29 patients), the splint was removed splint 2 weeks after treatment. All patients underwent a follow-up examination at 1, 2, and 4 weeks after treatment and were evaluated for tissue status and level of pain. After 1 year, we evaluated the rate of recurrence by means of a telephone interview with each patient. RESULTS: A low recurrence rate (8.7%) for the nail-splinting technique was observed in both groups (7.1% in group 1 vs. 10.3% in group 2). The tissue status and level of pain were found to improve with time, with no statistical significance between the two groups (P> 0.05). CONCLUSION: This study indicates that the nail-splinting technique constitutes a very simple and effective, noninvasive therapeutic method for treating ingrown nail. We suggest that the 3-day nail-splinting technique is the most useful when the nail is intact or has only a slight defect.     

Treatment of Recurrent Ingrown Great Toenail Associated with Granulation Tissue by Partial Nail Avulsion Followed by Matricectomy with Sharpulse Carbon Dioxide Laser

BACKGROUND: The effectiveness of partial nail avulsion followed by matricectomy with carbon dioxide (CO2) laser for the treatment of ingrown great toenails remains unclear. OBJECTIVE: This study sought to determine the effectiveness of partial nail avulsion followed by matricectomy with sharpulse CO2 laser in the treatment of recurrent ingrown great toenails associated with granulation tissue. MATERIALS AND METHODS: Fourteen patients with a total of 18 recurrent ingrown great toenails were randomly selected for participation in this study. Partial nail avulsions followed by matricectomy with sharpulse CO2 laser were performed on the involved nails. After at least 6 months, we evaluated the recurrence of ingrown toenails, regrowth of the nail spike, duration of post-treatment pain and post-treatment infection. RESULTS: Partial nail avulsion followed by matricectomy with sharpulse CO2 laser in the treatment of ingrown toenails resulted in a high cure rate, short postoperative pain duration and low risk of postoperative infection. CONCLUSION: This method we advocate is convenient and effective for the treatment of recurrent ingrown great toenail associated with granulation tissue.     

甲基质联合甲沟切除重建术治疗嵌甲性甲沟炎

目的：探讨一种治疗嵌甲性甲沟炎的方法并讨论其临床意义。方法：切除嵌甲、炎性肉芽组织及部分患趾甲基质,同时重建甲沟。结果：重建甲沟形态良好,效果满意,复发率低。结论：甲基质联合甲沟切除重建术是治疗嵌甲症的理想方法。     

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.     

趾端骨软组织矫形术在顽固性嵌甲中的应用

目的探讨趾端骨、软组织矫形术治疗顽固性嵌甲的临床效果。方法1997年10月-2006年5月，收治顽固性晦趾嵌甲患者31例38趾，采用白行设计的趾端骨、软组织矫形术治疗。男23例27趾，女8例11趾。年龄12～28岁，平均17．5岁。病程2年1个月～14年，平均31．6个月。均经5～9次拔甲治疗。合并甲沟炎急性期14例18趾，甲沟炎慢性期17例20趾。选取同期收治足部疾病但晦趾完整38例患者作对照。测量患者甲沟深度及摄X线片，测量爪粗隆上翘比例r值。结果患者甲沟深度及r值分别为2．87±0．31mm及0．149±0、013，与对照组1、06±0.10mm及0．060±k0．019比较，差异均有统计学意义（P〈0．01）。术后30例37趾伤口I期愈合，1例1趾伤口延迟愈合。29例36趾获随访8～29个月，平均21个月。趾端外形良好，无复发或再次手术。结论（足母）趾末节趾骨爪粗隆上翘、甲沟肥大变深是（足母）嵌甲重要的解剖学病因，采用趾端骨软组织矫形术是根治顽固性嵌甲的一种有效手术方法。     

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.     

甲基质联合甲沟切除术治疗顽固性嵌甲症

目的探讨甲沟切除术治疗顽固性嵌甲及疗效。方法对68例顽固性嵌甲病人行患侧甲基质联合甲沟切除术，观察其疗效、复发率及并发症发生情况。结果68例中1例复发，2例出现伤121感染，其余65例疗效理想。结论甲沟切除术疗效确切，复发率低，是治疗顽固性嵌甲症的理想术式。     

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??Deck orthopedic surgery in the treatment of cure obstinate ingrown nail: an analysis of 25 cases XIA Yue-shan*??ZHAO Hai-yong??MA Na .* Railway Central Hospital of Tangshan , Tangshan 063000??China
Corresponding author??ZHAO Hai-yong??E-mail??mana77@163.com
Abstract Objective To adopt a method for curing the obstinate ingrown nail by transplanting a soft tissue flap with a pedicel under the edge of the toenail in deck orthopedic surgery.??Methods The clinical data of deck orthopedic surgery to cure obstinate ingrown nail performed between February 2001 and June 2009 at Railway Central Hospital of Tangshan were analyzed. Remove prismatical skin at the edge of the toenail, design a soft tissue flap with a pedicel, strip off the edge of the toenail bed from the toebone, transplant a soft tissue flap with a pedicel under the edge of the toenail to alter the ingrowing toenai bed and deck deformity.??Results All cases of obstinate ingrown nail after the operation had recovered with satisfied results under 6 months to 1 years follow-up.??Conclusion The operation gets rid off the causes of obstinate ingrown first toenail, has few complications and few recurrences.     

The association between foot alignment and the development of ingrown toenails: A case-control study in a young adult military population

BackgroundThis case-control study aimed to explore an association between foot alignment and development and presentation of the ingrown toenail.MethodsRadiographs were evaluated for hallux interphalangeal angle (HIA), hallux valgus angle (HVA), talonavicular coverage angle (TNC), talo-first metatarsal (Meary’s) angle, and calcaneal pitch angle (CP), as well as medial sesamoid position in a cohort of 103 young and healthy patients (mean age of 20.5 years) with ingrown toenails. A control group of 63 patients was included, and the radiographic parameters were compared. Subgroup analysis was performed in patients with lateral (n = 65) or medial (n = 38) nail fold involvement.ResultsThe overall study group demonstrated a larger TNC and Meary’s angle and smaller CP than the control group, while no significant difference was found regarding the HIA and HVA. The lateral nail fold group had a larger HIA when compared to the medial nail fold group. Multiple regression analysis revealed that for ingrown toenail development, the only risk factor was a decrease in the CP. In the case of lateral nail fold involvement, an increase in the HIA found to be the only factor.ConclusionA lower medial longitudinal arch seems to be a predisposing factor in developing an ingrown toenail. The lateral nail fold involvement was associated with lateral deviation of the distal phalanx. The result of this study could provide information on prevention, treatment, recurrence, and patient counseling of an ingrown toenail in otherwise young and healthy individuals.     

甲板及甲基质部分切除联合拇趾腹重建甲沟治疗嵌甲性甲沟炎

目的探讨甲板及甲基质部分切除联合拇趾腹重建甲沟治疗嵌甲性甲沟炎的临床疗效。方法对76例嵌甲性甲沟炎患者采用甲板及甲基质部分切除联合拇趾腹重建甲沟术治疗,评价治疗效果。结果 76例均获随访,时间8~12个月。2例复发残甲,总有效率达97.4%。结论采用甲板及甲基质部分切除联合拇趾腹重建甲沟术治疗嵌甲性甲沟炎操作简便,对趾甲损伤小,患者痛苦轻,并发症少,治愈率高。     

100例嵌甲患者的手术治疗效果分析

目的：通过对100例嵌甲病人的手术治疗探讨部分甲皱襞和甲床切除术治疗甲沟炎的疗效。方法：对三种类型共100例甲沟炎病人施以部分甲皱襞和甲床切除术加以治疗。结果：共治疗100例,99治愈（其中80例一期愈合,19例感染,经引流、换药后二期愈合）。随访2～8个月,平均5个月,一例复发,无复发患者对趾甲外形满意。结论：嵌甲是引起甲沟炎主要的原因,部分甲皱襞和甲床切除术对治疗各类型嵌甲时手术操作简单,效果满意,复发率低,同时一定程度上有美甲作用。     

Partial Matricectomy with a CO2 Laser for Ingrown Toenail after Nail Matrix Staining

BACKGROUND: Ingrown toenail is a common nail disease that causes pain, discomfort, and difficulty in walking. It is treated with either conservative therapy or surgery. OBJECTIVE: To present a new surgical approach to ingrown toenail. MATERIALS AND METHODS: For 19 ingrown toenail borders of 14 toes in 14 patients (1 male and 13 females), the nail matrix was stained with methylene blue and then partial matricectomy was performed with a CO2 laser. RESULTS: There was no recurrence at 18 nail borders after a mean follow-up period of 13.4 months, whereas a spike grew at one border but caused no walking pain. No serious complications occurred. Cosmetic improvement was also satisfactory. CONCLUSIONS: Partial nail matricectomy with a CO2 laser after staining the nail matrix with methylene blue allows visual confirmation of the completeness of cauterization.     

48例嵌趾甲的病因分析及手术治疗

目的探讨趾嵌趾甲的病因,介绍一种新的手术治疗方法。方法对1997年10月至2003年10月我科收治的趾嵌甲患者48例51趾患者均进行手术治疗,咬除末节趾骨末端爪粗隆部分,梭形切除趾端及趾甲两旁软组织。随访观察趾端及趾甲的外形、了解嵌甲复发情况。结果所有病例平均随访26个月,47例50趾嵌甲治愈,1例1趾复发,经再次手术后治愈。结论趾末节趾骨爪粗隆突上翘是形成趾嵌甲的原因之一,咬除趾骨末端爪粗隆并梭形切除趾端及甲根两旁软组织是治疗嵌甲的一种有效方法。     

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.     

微创甲母质刮除术治疗嵌甲性甲沟炎206例术后疗效调查

目的：采用减少创伤,清除仅与疾病有关的肉芽、甲板、甲母质(nail matrix,或甲基质onychostroma)等病变组织术式治疗嵌甲性甲沟炎,并随访评估疗效。 方法：2010年-2013年6月,门诊手术治疗206例嵌甲性甲沟炎患者。术中剪除病变侧甲板3-4mm,并刮除与之相关的甲母质,刮出炎性肉芽,术后换药。 结果 术后随访6月-2年,复发13例,术后3月复发人数最多,复发率6.3%,优良率：93.6% 结论：微创甲母质刮出术,创伤小,手术简单,疗效满意,建议推广。     

Keloid formation on the great toe after chronic paronychia secondary to ingrown nail

Keloid is a clinically intractable fibro‐proliferative disease that spreads beyond the original scar or lesion. Although several theories have attempted to explain the mechanism of keloid formation, the phenomenon still remains obscure. Our present study examines a rare case of keloid formation that occurred on the great toe after a repeated paronychia secondary to an ingrown nail. The 22‐year‐old female patient had a large keloid with chronic paronychia and a history of ingrown nails on her left great toe on both the lateral nail folds. We excised the keloids and made new lateral nail grooves without extracting the nail. The open wounds were conservatively managed with the help of moisturized dressings until the wounds were completely epithelialised. Adjuvant therapies with oral medication, intermittent intralesional injection and toe care were performed during the follow‐up period. Histopathological analysis of the specimen revealed the presence of irregular, thick, glassy and dense collagen of keloid and inflammation of paronychia. During the 14‐month follow‐up period, adjuvant combination therapies successfully inhibited recurrence of keloid as well as paronychia and the normal appearance of the great toe was maintained. This study addresses a case of keloid formation on the great toe due to repeated recurrence of ingrown nails and consequent chronic paronychia. It is implied that if an ingrown nail is not controlled, it will result in the production of chronic inflammation and tension stress, which might trigger the formation of a secondary keloid.     

Matricectomy and nail ablation

Matricectomy refers to the complete extirpation of the nail matrix, resulting in permanent nail loss. Usually however, matricectomy is only partial, restricted to one or both lateral horns of the matrix. Nail ablation is the definitive removal of the entire nail organ. The most important common denominator in the successful matricectomy is the total removal or destruction of the matrix tissue. Matricectomy may be indicated for the management of onychauxis, onychogryphosis, congenital nail dystrophies, and chronic painful nail, such as recalcitrant ingrown toenail or split within the medial or lateral one-third of the nail.     

A Surgical Approach to Ingrown Nail: Partial Matricectomy Using CO2 Laser

BACKGROUND: Ingrown nail is a deformity characterized by a transverse overcurvature of the lateral nail plate that causes nail fold inflammation. Currently recommended surgical procedures vary considerably. OBJECTIVE: We report our experience with a modified partial matricectomy and nail edge excision with CO2 laser. METHODS: A total of 116 ingrown nail edges in 77 patients were treated with the procedure. RESULTS: The incidence of recurrence was 2 of 76 cases (2.6%). CONCLUSION: This new surgical approach was found to be effective and is presented as an alternative treatment technique.     

Surgical options in the management of ingrown toenails in paediatric age group

Background and objectiveThe problem of ingrown toenails is worldwide, affecting all age groups. The aim of this study was to review the different surgical modalities for ingrown toenails in the paediatric age group in a hospital.MethodsWe reviewed case series of 66 children with 89 affected toes, under 16 years of age. The patients were followed up for up to 18 months. The treatment methods practised were: (1) nail avulsion with or without nail matrix ablation using phenol and (2) wedge excision with or without nail matrix ablation using phenol or thermal ablation.ResultsWe found a recurrence rate of 3% for those treated with wedge excision alone compared to 30% when treated with wedge excision and phenol ablation (p = 0.001). Infection rate was also higher for wedge excision with phenol ablation. We achieved cure rate of 97% when using wedge excision alone and 70% when phenol was used for nail matrix ablation.ConclusionWe advocate wedge excision as primary treatment of ingrown toenails in children. We would not recommend phenol ablation of the nail matrix in younger patients as it increases both infection and recurrence rates. The results of nail bed ablation with diathermy appear promising.