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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.
BACKGROUND: Several options for the treatment of ingrowing toenails are available, ranging from simple conservative approaches to extensive surgical procedures.
OBJECTIVE: To evaluate in a long-term follow-up (36 months) the efficacy of chemical matricectomy with phenol for the treatment of ingrowing toenails.
METHODS AND MATERIALS: A total of 197 phenol ablations were performed in 139 patients with stage 2 and 3 disease. Each patient was examined weekly until full wound healing was achieved and was followed for 36 months to assess the long-term efficacy of the treatment. The healing period after surgery ranged from 2 to 4 weeks; few postoperative complications were seen.
RESULTS: Only three recurrences were observed (after 2, 4, and 11 months). Short-term results were excellent. No severe complications occurred during the 36-month follow-up period. Cosmetic results were remarkable. The success rate was 98.5%.
CONCLUSIONS: Phenol cauterization is an excellent surgical method for the treatment of ingrowing toenails, being simple and associated with low morbidity and a high success rate, even over the long term (36 months).
Ingrowing toenails are a common condition which, when recurrent and painful, are often treated surgically.
To evaluate the effectiveness of methods of the surgical treatment of ingrowing toenails.
Electronic database searching (CENTRAL, MEDLINE, EMBASE, CINAHL) followed by investigation of reference lists of the papers identified from the initial search.
Any randomised (or quasi-randomised) controlled trial which compares one form of surgical removal of all or part of a toenail due to its impact on the soft tissues to another or others. Studies must have a minimum follow period of six months and aim to permanently remove the troublesome portion of the nail.
Data collection and analysis
Data extraction was carried out independently by the two authors using a pre-derived data extraction form and entered into RevMan. Categorical outcomes were analysed as odds ratios with 95% confidence intervals.
Avulsion with phenol versus surgical excision
Phenolisation combined with simple avulsion of a nail is more effective than the use of more invasive excisional surgical procedures to prevent symptomatic recurrence at six months or more (OR 0.44; 95% CI 0.24 to 0.80).
Avulsion with phenol versus avulsion without phenol
The addition of phenol, when performing a total or partial nail avulsion dramatically reduces the rate of symptomatic recurrence, (OR 0.07; 95% CI 0.04 to 0.12). This is offset by a significant increase in the rate of post-operative infection when phenol is used (OR 5.69; 95% CI 1.93 to 16.77).
The evidence suggests that simple nail avulsion combined with the use of phenol, compared to surgical excisional techniques without the use of phenol, is more effective at preventing symptomatic recurrence of ingrowing toenails.
The addition of phenol when simple nail avulsion is performed dramatically decreases symptomatic recurrence, but at the cost of increased post-operative infection.
Anyone has any stats for the chances of regrowth after a PNA procedure? Or any other stats relevant PNAs?
Here you go mate;
'The phenol alcohol partial chemical matri-
cectomy has been discussed by many authors.
Rinaldi et al dealt with the problem of treat-
ment and prevention of infection, and Siegle et
al present the data on 30 patients and Robb
and Murrayzg on 151 toes. The recurrence rates
were 2% and 4%, respectively. '
- Nail Surgery -
Richard K, Scher. MD -
"Avulsion with phenol versus avulsion without phenol
The addition of phenol, when performing a total or partial nail avulsion dramatically reduces the rate of symptomatic recurrence..."
I would submit that if a patient has a pyogenic paronychia with no previous history of a similar condition then a simple partial nail resection (call it what you will) may in fact give long term results. Not because the procedure itself is corrective but because the patient simply is not predisposed to recurrent infections.
If, on the other hand, a patient gives a history of recurrent pyogenic paronychias at any given site, then a simple partial nail resection (without matrixectomy) will likely do nothing more than treat the immediate infection.
In essence, it's the selection of the sample group in these studies that will effect the results. If they are selected only by whether they have an infected nail and not by historical prevalence of infection, then the results will
be in favor of successful long term treatment.
I can't think of an easier procedure then the Partial Phenol and alcohol procedure. If you are getting 5% failure rate then I would assume you would need to refine your technique.
Fairly simple stuff I think.
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
Interesting you say that mate, the same would go for 95% of other podiatry related sample populations that are utilised. However, the predisposition to recurrent infection lies perfectly in the systemic health of the patient and not necessarily on whether or not there was infection prior. A pyogenic paronychia will usually also need antibiotic treatment in the immunosuppresed or compromised individual, such as those patients presenting with elevated BGL, HBA1c, Lupus etc.