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recently a 36 y/o male consulted me in ragards to his right 1st nail, which he had treated by a podiatrist for onychocryptosis 2 yrs previously. the podiatrist (believe it or not) cut a V-shape into the proximal edge of the nail, causing the nail to split straight the middle of the nail. although this cured the O/C, the patient is now left with a permanently split nail, that i presume involes the matrix. the patient often has to file the dorsal surface of the nail as the 2 parts of the nail overlap.
the patient has very broad, fan-shaped nails.
what is the best way to treat this surgically??
1) NWR with phenol matrisectomies to both sides of the nail, which might allow for more "room" for the nail to grow out without overlapping.
2) complete nail avulsion without phenol matrisectomy, which might allow the nail to grow back normally.
Personally I'd do a Bilateral partial avulsion WITH phenol to get the nail to a reasonable size and shape then avulse the remaining part of the nail WITHOUT phenol to try to prevent the split (as part of the same proceedure.)
But I'm a biomechanist, What the hell do i know about nail surgery?
personally i'd question the history the patient has given you, i'd be suprised if cutting a V:-
a. did actually cure an oc
b. caused the split, some type of trauma to the nail bed more proximally would be my guess
if the problem has persisted for 2 years i'd say that simply removing the nail is unlikely to resolve the problem and the trauma of nail surgery may result in a worsening of the problem or onychogryphosis.
cutting the V did not resolve the O/C. the subsequent overlapping of the nail at the split did. and yes i did query the splitting of the nail being due to the cutting of the V, and the patient assures that this was so.
I would, and have done in the past, perform a total nail avulsion without phenol. `it heals quickly and if there is a chance to save the nail that would be preferable on a patient of that age. If the nail still grows with a split, then total nail avulsion with phenol could be an option