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.     

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.     

Recurrent Ingrown Big Toenails Are Efficiently Treated by CO2 Laser

BACKGROUND: Surgery for onychocryptosis has a high rate of recurrence. OBJECTIVE: To evaluate CO2 laser partial matricectomy for recurrent onychocryptosis. METHODS: One hundred ninety-six consecutive patients (predominantly teenagers) previously unsuccessfully treated by surgery underwent CO2 laser for recurrent onychocryptosis. After a digital nerve block and a simple partial nail plate avulsion, the laser was used (5 W, defocused 2 mm beam in continuous mode) to vaporize the matrix, the lateral horn, and the lateral nail groove, including local granulation tissue if present. Follow-up was at least 12 months. RESULTS: Three hundred forty-four matricectomies were performed. Disease was mostly at stage II and III, with severe local infection in 24 cases (12.2%). All wounds healed in 21.9 +/- 3.2 days, with no postoperative local infection or prolonged exudative drainage. Onychocryptosis reoccurred in 5 of 344 treated margins (1.45%, average 15 months), all after primary bilateral matricectomy. Spicules in the lateral nail groove occurred in 14 of 344 treated margins (4%, average 5.9 months), mostly after primary bilateral matricectomy (7 cases) and in infected margins (8 cases). One patient developed a neuroma in the lateral nail groove. CONCLUSION: CO2 laser is effective for the treatment of recurrent onychocryptosis. Bilateral matricectomy and local infection seem to be the predisposing factors for recurrence and postoperative spicule growth.     

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.     

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 prospective comparison of wedge matrix resection with nail matrix phenolization for the treatment of ingrown toenail

In a prospective study, 110 patients with ingrown toenails were operated on, 55 with wedge matrix resection (WMR) and 55 with nail matrix phenolization (NMP). The patients were randomized on the basis of their address. All patients were reviewed by questionnaire 4 weeks postoperatively to establish the degree of pain, time of pain relief, walking and working ability, and the presence of infection. Furthermore, they were examined clinically at a median follow-up time of 11 months postoperatively to evaluate recurrence rate, rate of spicula formation, and patient satisfaction with regard to cosmesis and symptom relief. The data were tested for statistical significance using the chi-square test and Mann-Whitney rank sum test. The recurrence rate of ingrown toenail for the WMR group was 5.5% (3 patients) with a spicula rate of 36% (20 patients) and a reoperation rate of 20% (9 patients). In the NMP group, there were no recurrences (p = n.s.), the spicula rate was 7.3% (4 patients) (p < .005) and no patients were reoperated on (p < .016). Patient satisfaction with less pain and earlier pain relief was greatest in the NMP group. These results indicate that nail matrix phenolization is an efficient therapy for ingrown toenails and may be preferable to nail wedge resection.     

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。     

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.     

Carbon dioxide laser use for certain diseases of the toenails

The CO2 laser has facilitated the treatment of many toenail conditions. Satisfactory wound healing and cure rates have been equivalent to current standards of treatment. Pain was markedly diminished as compared with pain in traditional methods of treatment, and time until comfortable ambulation was dramatically shortened. Healing times were consistent with those in other methods of treatment. The protocol for CO2 treatment of nail conditions has been thoroughly described. Evaluation of 50 patients after 4 years from treatment date is tabulated. The CO2 laser must be strongly considered as a treatment modality for toenail pathology. Because of markedly reduced pain, minimal disability, and satisfactory long-term results, the laser is becoming a valuable treatment of choice for pathologic conditions of the nail.     

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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.     

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。     

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.     

Treatment of the ingrown toenail by phenol cauterization (ASLUF)

BACKGROUND: The aim of this study was to evaluate the clinical and the ethiopatogenetic aspects of the ingrown toenail, treated by usual surgical technique versus phenol wedge cauterization (ASLUF). METHODS: From June 1990 to June 1999, 388 patients (218 male and 170 female patients, age range 9-90 years) were treated by 413 wedge ablation, surgical or chemical. After the operation, patients were controlled after 2 days, 1 week, 1 month, 6 months and 1 year. 109 patients were treated by usual surgical treatment, 260 patients by phenol cauterization (ASLUF), 19 by total ablation. RESULTS: 23 patients presented again ingrown toenail in the same place after few months, 20 patients after surgical treatment and 3 patients after phenol cauterization. All 23 patients were treated again without problems. CONCLUSIONS: In our personal opinion, the treatment of ingrown toenail is necessary soon, without the routine use of antibiotic therapy and the total ablation of the nail is not necessary. On this basis phenol wedge cauterization is the most suitable treatment for ingrown toenail with good cosmetic results, lower recurrence rate and from the functional point of view.     

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.     

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.     

Congenital ingrown toenail of the hallux

BACKGROUND: Ingrown toenail in the infant is a rare entity that has only occasionally been discussed in the medical literature. At birth, or soon thereafter, children present with bilateral ingrown hallux toenails notable for pain, tenderness, erythema, purulence, and hypertrophy of the skin and fat of the distal end of the great toes extending over the dorsum of the nail plates. Inflammatory and infectious granulation tissue develops with time. METHODS: We present a case series of 4 patients with bilateral congenitally ingrown hallux toenails. Conservative and surgical treatment modalities were used, with 3 of 4 patients undergoing wedge resection of the hypertrophic soft tissues at the distal end of the toes. RESULTS: There were excellent results in both feet of all patients with resolution of the condition and no recurrences in any patient. Clinical photos are provided for all patients. CONCLUSIONS: Ingrown toenail in the infant is a rare entity that occasionally requires surgical treatment. Excellent results are expected with wedge resection of the hypertrophic soft tissues.     

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。     

Zur Behandlung des eingewachsenen Zehennagels

In Germany,"Emmert plasty" is one of the terms most frequently used in daily surgical practice. It describes the wedge excision of nail fold, nail edge, and corresponding matrix for advanced stages of ingrown toenail in most standard textbooks of surgery but without direct reference to Emmert. The method, however,was apparently first described by the French military surgeon Baudens in 1850 and was strongly opposed by Emmert himself who propagated a pure soft tissue resection. This text gives a short historical review of the various treatment methods of ingrown toenails.     

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.