新手术方法治疗嵌趾甲患者的护理

对48例(51趾)嵌趾甲患者采用咬骨钳咬除末节趾骨、梭形切除趾端及趾甲两旁软组织的新手术方法治疗,术前合理选用抗生素,做好患足的准备工作,专科化备皮,并加强心理护理,耐心讲解新手术方法的优点和注意事项;术后注意观察患趾病情变化,减轻疼痛,保持局部卫生,加强营养,减少嵌趾甲的复发率等护理措施.结果手术均顺利,平均随访26.0个月,47例(50趾)嵌甲治愈,1例(1趾)复发,经再次手术后痊愈.     

新手术方法治疗嵌趾甲患者的护理

对48例（51趾）嵌趾甲患者采用咬骨钳咬除末节趾骨、梭形切除趾端及趾甲两旁软组织的新手术方法治疗，术前合理选用抗生素，做好患足的准备工作，专科化备皮，并加强心理护理，耐心讲解新手术方法的优点和注意事项；术后注意观察患趾病情变化，减轻疼痛，保持局部卫生，加强营养，减少嵌趾甲的复发率等护理措施。结果手术均顺利，平均随访26．0个月，47例（50趾）嵌甲治愈，1例（1趾）复发，经再次手术后痊愈。     

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。     

(足母)趾腹成形联合甲沟重建治疗复发性嵌甲的临床研究

嵌甲是临床常见多发病，它是趾两旁背侧皮肤与皮下组织挤压趾甲，或趾甲边缘甲体嵌入甲沟软组织中，引起的炎症和感染。临床上有多种治疗方法犤１，２犦，如甲缘分离、酚处理甲母质、韧带夹管、趾甲完整拔除、趾甲部分拔除、趾甲皮肤楔形切除、趾甲及甲床部分切除、甲床彻底切除以及甲沟重建等，但术后复发率均较高。我们设计了趾腹成形＋甲沟重建术治疗复发性嵌甲，获得了较好的疗效。资料与方法一、临床资料自１９８７年７月～２００１年１２月收治复发性嵌甲患者１９２例，男１１７例，女７５例；平均年龄２７．３岁（１６～７３岁），以…     

指(趾)甲分型及对甲沟炎的治疗研究

目的 通过对指(趾)甲的分型探索治疗甲沟炎的最佳手术方法。方法 将指(趾)甲分成3个类型，根据不同类型的甲沟炎施以不同的手术。嵌甲型、扁平型采用甲床部分切除，少数病例采用拨甲治疗。凹陷型行甲床部分切除加指(趾)侧梭形切皮整形术，少数病例行甲床部分切除。结果 共治疗437例，治愈410例，复发27例。结论 嵌甲是引起甲沟炎主要的原因。嵌甲型、扁平型甲沟炎采用甲床部分切除根除了嵌甲的情况，疗效甚佳。凹陷型行甲床部分切除加趾侧梭形切皮整形后，甲缘平面被降低，避免了组织受压，治疗后不易复发。     

甲床矫形术治疗顽固性嵌甲25例分析

目的 总结带蒂软组织瓣甲床侧缘下移植,进行甲板整形手术,彻底治愈顽固性嵌甲的经验。方法 对2001年2月至2009年6月唐山铁路中心医院收治的25例顽固性嵌甲的临床资料进行分析。设计带蒂软组织瓣,将甲床侧缘从趾骨上剥离,用软组织瓣填塞其下支撑甲床,使甲床垫起,甲沟变浅,矫正其侧下翻畸形,矫正畸形甲板。 结果 25例（34趾）顽固性嵌甲均行病变甲基质部分切除、带蒂软组织瓣甲床侧缘下移植手术。随访6个月至1年均取得满意疗效。 结论 甲床矫形术去除了嵌甲的病因,外形美观,手术并发症少,复发率低。     

甲床部分切除联合甲沟重建治疗嵌甲性甲沟炎

目的探讨甲床部分切除联合甲沟重建治疗嵌甲性甲沟炎的临床疗效。方法对48例（51足）嵌甲性甲沟炎采用甲床部分切除联合甲沟重建手术治疗,手术前0.5%碘伏浸泡患趾,切除增生的肉芽组织及病变甲沟,纵形切除约1/5甲床,重建甲沟,术后加压包扎,抗炎换药治疗。结果本组均获随访,随访时间4个月～2年,术后复发1例,二次手术后痊愈;术后感染2例;其余患者甲沟重建外观美观、无复发,患者满意。结论嵌甲性甲沟炎采用甲床部分切除联合甲沟重建治疗,可以取得满意的疗效。     

改良的甲板及甲基质部分切除治疗嵌甲性甲沟炎

目的探讨改良的甲板及甲基质部分切除治疗嵌甲性甲沟炎的临床疗效。方法选择2012年7月-2016年3月收治的86例95趾足部嵌甲性甲沟炎患者,采用患侧部分拔甲、甲基质部分(约1/5)切除、甲床外翻抬高、增生肉芽组织切除联合甲襞修整方法治疗,观察术后疗效。结果患者术后愈合佳,除3例术后创面感染,再次清创后愈合,其余切口均Ⅰ期愈合。81例获随访,随访时间10个月~4年,平均12.4个月,患者趾甲外观完整,患趾感觉及运动功能正常,无复发,无并发症、后遗症发生。结论该术式是目前治疗嵌甲性甲沟炎的有效方法之一,手术时间短、微创、方法简单可行、恢复快、治愈率高、远期疗效确切,尤其不影响甲部整体外形美观,患者易于接受,值得推广。     

第Ⅱ趾骨甲皮瓣移植中指指腹复位末节再造一例

第Ⅱ趾骨甲皮瓣移植中指指腹复位末节再造一例宋修军，杨利民，葛忠患者男，３１岁。右中指挤压伤末节缺如并残端痛半年。查见右中指末节指骨及背侧组织缺失．指腹被翻向指背殖端。手术将中指原指腹分离复位并显露骨端，切取同侧第Ⅱ趾甲皮瓣连同末节趾骨游离移植于中指残...     

趾甲下骨疣合并甲床周围软组织感染6例报告

发生在趾骨末节甲床下的骨软骨瘤即甲下骨疣是一种少见的骨软骨瘤 (图 1) ,由于早期可无明显临床症状而不引起注意 ,往往是有合并症出现才到医院就诊。本院 1992年至今共收治 6例趾甲下骨疣合并甲床周围软组织感染患者 ,经抗炎后手术治疗 ,取得满意疗效。现报告如下 :图 2　男性　 2 4岁 ,　趾正位片示甲下骨疣1　临床资料1.1　患者 ,男性 4例 ,女性 2例 ,年龄 17～ 45岁 ,平均 2 3岁。右足 4例 ,左足 2例。1.2　治疗方法　病人确诊后 ,2例患者门诊拔甲、换药 ,炎症治愈后收入院手术切除 ,3例患者入院后静脉抗炎、拔甲、换药后手术治疗 …     

A new anatomical repair method for the treatment of ingrown nail: prospective comparison of wedge resection of the matrix and partial matricectomy followed by lateral fold advancement flap

Currently, there are various surgical treatment modalities for ingrowing nail. None of these procedures are perfect to achieve esthetic results with low cost, recurrence, and complication rates. Eighty-seven toenails of 77 patients were operated in our clinic; 49 wedge matrix resections (WMR) and 38 partial matricectomy followed by lateral fold advancement flap (LFAF) were applied. Average follow-up period of the patients was 13 months. The recurrence rates, spicule formation, immobilization periods, and patient satisfaction for cosmetic result and discomforting symptoms were investigated. Nail, distal phalanx bone, soft tissue measurements were performed in the counterlateral healthy toe of 34 patients that we operated due to the unilateral ingrowing nail and 34 randomized individuals with no ingrowing nail by lateral and anteroposterior toe x-rays. There were no significant differences for age, sex, the side of the ingrowing nail, postoperative mobilization period, and the follow-up period between 2 groups that the techniques were applied to. There was no statistically significant difference in WMR (8.1%, 4 toes) and LFAF (none) for the recurrence rate. But there was significant difference between WMR (36.7%, 18 toes) and LFAF (5.2%, 2 toes) for the spicule formation rates (P < 0.05), and there was significant difference between WMR (20.4%, 10 toes) and LFAF (none) for the reoperation (P < 0.03). It was observed that patient satisfaction in cosmetic view was better in patient group treated with LFAF (P < 0.05). Phalanx heads were wider in patient group with ingrowing nail at the results of the measurements (P < 0.01). The fact that granulation and scarred tissues are removed instead of performing the great soft tissue excisions is more correct for both recurrence and cosmetics. Partial matricectomy and LFAF is a good alternative method for the treatment of ingrown nail, with less recurrence rates and cost and better cosmetic results.     

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。     

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.     

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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.     

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.     

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.     

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 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.     

Is there a relationship between forefoot alignment and ingrown toenail? A case-control study

Biomechanical imbalance between the hallux and the second toe and external compression of the lateral nail fold are proposed as the main reasons for ingrown toenail. Therefore, any anatomical predisposition facilitating this compression may play a role in the occurrence of ingrown toenail. The purpose of this study is to investigate the relationship between forefoot alignment and ingrown toenail. The authors retrospectively reviewed radiographs of 81 patients with ingrown toenails and compared them with 100 healthy subjects regarding forefoot alignment. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and interphalangeal angle (IPA) were measured, and feet were classified according to digital formula as Egyptian, Greek, and square. The mean HVA was 14.5° ± 5.0° in the case group and 13.2° ± 5.9° in the control group. The mean IMA was 9.1° ± 2.5° in the case group and 8.6° ± 3.1° in the control group. The mean IPA was 11.9° ± 4.1° in the case group and 12.0° ± 5.1° in the control group. There was no statistically significant difference between the groups regarding HVA, IMA, or IPA (P = .123, P = .198, and P = .925, respectively). The distribution of foot types between groups was also similar (P = .967). This study has failed to demonstrate any abnormality in forefoot alignment in patients with symptomatic ingrowing toenails, and it is suggested that treatment should not be based on the correction of the anatomy if no abnormality exists.