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BACKGROUND: The aim of this study was to investigate different surgical techniques for treating ingrowing toenails (IGTNs) and to determine the value of a locally applied antibiotic after intervention.
METHODS: One hundred and twenty-three patients with IGTN were assigned randomly to one of four groups. All patients had partial nail avulsion. This was combined with excision of the matrix or application of phenol, with or without local application of gentamicin afterwards. All procedures were performed by one physician. The primary outcome measure was symptomatic recurrence of IGTN.
RESULTS: One hundred and seventeen patients were available for follow-up. Phenol gave significantly better results than matrix excision with respect to recurrence (including regrowth and spike formation) after 1 year (P < 0.001). In terms of signs of infection, there was no significant difference between phenol and matrix excision after 2 days (P = 0.224) or 1 week (P = 0.501). Antibiotics had no effect in reducing the risk of infection after 2 days (P = 0.989) or 1 week (P = 0.676), or in reducing the rate of recurrent IGTN at 1 year (P = 0.187). If regrowth or spike formation is included, the effect is even less significant (P = 0.876).
CONCLUSION: Partial nail avulsion with phenolization gave better results than partial avulsion with matrix excision. Local antibiotics did not reduce signs of infection or recurrence. Use of phenol did not produce more signs of infection than matrix excision.
OBJECTIVES: Ingrowing toe nail is a frequent disorder of the foot. In this study, we evaluated the results of surgical treatment of ingrowing toe nail.
METHODS: Sixty-two patients (31 males, 31 females; mean age 38 years; range 11 to 72 years) with ingrowing toe nail underwent partial removal of the nail matrix according to the Winograd technique. The presenting complaints were pain, foul-smelling drainage, deformity, and difficulty in walking. According to the Heifetz's staging system, 18 patients had stage I, 23 patients had stage II, and 21 patients had stage III disease. Forty-four patients had active drainage due to an infectious process. The infected cases were operated on after improvement of inflammation by antibiotic treatment. One patient underwent excision of subungual exocytosis causing severe deformity of the toe. Time to return to work, time to recurrence, and patient satisfaction were evaluated. The mean follow-up period was 26 months (range 24 to 42 months).
RESULTS: Recurrence was seen in four patients (6.5%) within a mean of 4.2 months (range 3 to 7 months). The remaining patients returned to normal daily activities after a mean of 12 days (range 10 to 16 days). The mean time to work was five days (range 3 to 16 days). All but two patients who developed recurrences expressed satisfaction with surgery. None of the patients had deep infection or neurovascular complications.
CONCLUSION: Partial removal of the nail matrix is associated with a very low recurrence rate and a higher rate of patient satisfaction.
I'm a final year podiatry student and am undertaking a research proposal in an attempt to discover the cost effectiveness of phenol vs sodium hydroxide during nail surgery and matrixectomies. Reading past papers I get the impression that regrowth rates are similar for both methods but both slightly differ in healing times? I would guess therefore one would require less re-dressing appointments etc and would make it a more financially viable option.
I'm just wondering if anyone has heard of a similar study that has been conducted- focussing primarily on cost effectiveness as I can't seem to find one. Any questions or comments regarding this topic would be much appreciated.
RCT of ingrown nail surgery techniques
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