CONSEQUENCES OF WEDGE RESECTION PROCEDURE WITH A NEW SUTURE TECHNIQUE IN THE TREATMENT OF INGROWN TOENAILS

Abstract

Aim: The narrowing of the nail plate or debulking of soft tissues is the mainstay of the different surgical techniques used to treat ingrown toenails. However, neither of these methods is sufficient alone to treat all types of ingrown toenail. The aim of this study was to present a new surgical wedge resection procedure for an ingrown toenail that includes a definitive narrowing of the nail plate, debulking of the lateral fold and attachment of the remaining lateral fold to the nail plate using a novel suturing technique.

Material and Methods: Fifty two patients with grade 2-3 ingrown toenails were operated on. Twelve of these cases involved bilateral toes and 11 toes had bilateral lesions; 75 lesions on 64 toes were therefore surgically treated. Recurrence and cosmetic satisfaction were the main outcomes to be assessed.

Results: No recurrence was detected in any subject and all patients were satisfied with the cosmetic results.

Conclusion: Our new surgical procedure is a very effective alternative treatment for an ingrown toenail which produces excellent cosmetic results.

Keywords

• Ingrown toenail,surgical procedures

Tırnak Batmalarının Tedavisinde Kama Şeklinde Çıkarımla Birlikte Yeni Bir Sütür Tekniğinin Sonuçları

Abstract

Amaç: Tırnak batmalarında tırnak yatağının daraltılması ve yumuşak dokudaki şişliklerin giderilmesi birçok cerrahi müdahalenin ortak noktasıdır. Ancak bu cerrahi tekniklerin hiçbiri tek başına cerrahi tedavide yeterli olmamaktadır. Bu çalışmada amaç kama şeklinde etraf yumuşak dokuda eksizyon yapılarak tırnak yatağının daraltılması ve kalan yumuşak dokuların ise yeni geliştirilen bir sütür tekniği ile yeniden tırnak yatağı oluşturulmasını sağlamaktır.  

Gereç ve Yöntem: Çalışmamıza sınıf 2-3 tırnak batması olan 52 hasta dahil edildi. Bu olguların 12’sinde her iki ayakta ve 11’inde ise aynı ayakta tırnağın her iki tarafındatırnak batması mevcuttu. Toplam 64 ayaktaki 75 lezyon cerrahi olarak tedavi edildi. Nüks ve kozmetik memnuniyet açısında sonuçlar değerlendirildi.

Bulgular: Hiçbir hastada nüks görülmedi ve tüm hastalar kozmetik sonuçlardan memnundu

Sonuç: Yeni geliştirilen bu cerrahi tekniğin tırnak batması tedavisinde çok etkili, mükemmel kozmetik sonuçlar doğuran alternatif bir yöntem olduğunu düşünmekteyiz. 

Keywords

• Tırnak batması,cerrahi işlemler

References

1. Baran R. The nail in the elderly. Clinics in dermatology. 2011;29(1):54-60. doi:10.1016/j.clindermatol.2010.07.008.
2. Richert B. Surgical management of ingrown toenails - an update overdue. Dermatologic therapy. 2012;25(6):498-509. doi:10.1111/j.1529-8019.2012.01511.x.
3. Chapeskie H. Ingrown toenail or overgrown toe skin?: Alternative treatment for onychocryptosis. Canadian family physician Medecin de famille canadien. 2008;54(11):1561-2.
4. Daniel CR, 3rd, Iorizzo M, Tosti A, Piraccini BM. Ingrown toenails. Cutis. 2006;78(6):407-8.
5. Langford DT, Burke C, Robertson K. Risk factors in onychocryptosis. The British journal of surgery. 1989;76(1):45-8.
6. Zuber TJ, Pfenninger JL. Management of ingrown toenails. American family physician. 1995;52(1):181-90.
7. Heidelbaugh JJ, Lee H. Management of the ingrown toenail. American family physician. 2009;79(4):303-8.
8. Uruc V CN, Selcuk CT, Donmez M. . Partial wedge resection of nail, nail bed and nail matrix in ingrown toenail treatment. . Klinik Ve Deneysel Arastirmalar Dergisi 2010;1:37-40.

9. Heifetz CJ. Operative management of ingrown toenail. Missouri medicine. 1945;42:213-6.
10. Gerritsma-Bleeker CL, Klaase JM, Geelkerken RH, Hermans J, van Det RJ. Partial matrix excision or segmental phenolization for ingrowing toenails. Arch Surg. 2002;137(3):320-5.
11. Nishioka K, Katayama I, Kobayashi Y, Takijiri C. Taping for embedded toenails. The British journal of dermatology. 1985;113(2):246-7.
12. Senapati A. Conservative outpatient management of ingrowing toenails. Journal of the Royal Society of Medicine. 1986;79(6):339-40.
13. Wallace WA, Milne DD, Andrew T. Gutter treatment for ingrowing toenails. British medical journal. 1979;2(6183):168-71.
14. Schulte KW, Neumann NJ, Ruzicka T. Surgical pearl: nail splinting by flexible tube--a new noninvasive treatment for ingrown toenails. Journal of the American Academy of Dermatology. 1998;39(4 Pt 1):629-30.
15. Arai H, Arai T, Nakajima H, Haneke E. Formable acrylic treatment for ingrowing nail with gutter splint and sculptured nail. International journal of dermatology. 2004;43(10):759-65. doi:10.1111/j.1365-4632.2004.02342.x.
16. Harrer J, Schoffl V, Hohenberger W, Schneider I. Treatment of ingrown toenails using a new conservative method: a prospective study comparing brace treatment with Emmert's procedure. Journal of the American Podiatric Medical Association. 2005;95(6):542-9.
17. Watabe A, Yamasaki K, Hashimoto A, Aiba S. Retrospective Evaluation of Conservative Treatment for 140 Ingrown Toenails with a Novel Taping Procedure. Acta dermato-venereologica. 2015. doi:10.2340/00015555-2065.
18. Tsunoda M, Tsunoda K. Patient-controlled taping for the treatment of ingrown toenails. Annals of family medicine. 2014;12(6):553-5. doi:10.1370/afm.1712.
19. Bostanci S, Ekmekci P, Gurgey E. Chemical matricectomy with phenol for the treatment of ingrowing toenail: a review of the literature and follow-up of 172 treated patients. Acta dermato-venereologica. 2001;81(3):181-3.
20. Kayalar M, Bal E, Toros T, Ozaksar K, Gurbuz Y, Ademoglu Y. Results of partial matrixectomy for chronic ingrown toenail. Foot & ankle international. 2011;32(9):888-95.
21. Andre P. Ingrowing nails and carbon dioxide laser surgery. Journal of the European Academy of Dermatology and Venereology : JEADV. 2003;17(3):288-90.
22. Ozawa T, Nose K, Harada T, Muraoka M, Ishii M. Partial matricectomy with a CO2 laser for ingrown toenail after nail matrix staining. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al]. 2005;31(3):302-5.
23. Lin YC, Su HY. A surgical approach to ingrown nail: partial matricectomy using CO2 laser. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al]. 2002;28(7):578-80.
24. Hettinger DF, Valinsky MS, Nuccio G, Lim R. Nail matrixectomies using radio wave technique. Journal of the American Podiatric Medical Association. 1991;81(6):317-21. doi:10.7547/87507315-81-6-317.
25. Sarifakioglu E, Sarifakioglu N. Crescent excision of the nail fold with partial nail avulsion does work with ingrown toenails. European journal of dermatology : EJD. 2010;20(6):822-3. doi:10.1684/ejd.2010.1062.
26. Chapeskie H, Kovac JR. Case Series: Soft-tissue nail-fold excision: a definitive treatment for ingrown toenails. Canadian journal of surgery Journal canadien de chirurgie. 2010;53(4):282-6.
27. Tweedie JH, Ranger I. A simple procedure with nail preservation for ingrowing toe-nails. Archives of emergency medicine. 1985;2(3):149-54.
28. Noel B. Surgical treatment of ingrown toenail without matricectomy. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al]. 2008;34(1):79-83. doi:10.1111/j.1524-4725.2007.34012.x.
29. Shaath N, Shea J, Whiteman I, Zarugh A. A prospective randomized comparison of the Zadik procedure and chemical ablation in the treatment of ingrown toenails. Foot & ankle international. 2005;26(5):401-5.
30. Kose O, Guler F, Gurcan S, Arik HO, Baz AB, Akalin S. Cosmetic results of wedge resection of nail matrix (Winograd technique) in the treatment of ingrown toenail. Foot & ankle specialist. 2012;5(4):241-4. doi:10.1177/1938640012444729.
31. Huang JZ, Zhang YJ, Ma X, Wang X, Zhang C, Chen L. Comparison of wedge resection (Winograd procedure) and wedge resection plus complete nail plate avulsion in the treatment of ingrown toenails. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons. 2015;54(3):395-8. doi:10.1053/j.jfas.2014.08.022.
32. Aksoy B, Aksoy HM, Civas E, Oc B, Atakan N. Lateral foldplasty with or without partial matricectomy for the management of ingrown toenails. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al]. 2009;35(3):462-8. doi:10.1111/j.1524-4725.2009.01067.x.
33. Aydin N, Kocaoglu B, Esemenli T. [Partial removal of nail matrix in the treatment of ingrowing toe nail]. Acta orthopaedica et traumatologica turcica. 2008;42(3):174-7.
34. Herold N, Houshian S, Riegels-Nielsen P. A prospective comparison of wedge matrix resection with nail matrix phenolization for the treatment of ingrown toenail. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons. 2001;40(6):390-5.
35. Shaikh FM, Jafri M, Giri SK, Keane R. Efficacy of wedge resection with phenolization in the treatment of ingrowing toenails. Journal of the American Podiatric Medical Association. 2008;98(2):118-22.
36. Rounding C, Bloomfield S. Surgical treatments for ingrowing toenails. The Cochrane database of systematic reviews. 2005(2):CD001541. doi:10.1002/14651858.CD001541.pub2.
37. Ince B, Dadaci M, Altuntas Z. Knot technique: a new treatment of ingrown nails. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al]. 2015;41(2):250-4. doi:10.1097/DSS.0000000000000271.
38. Rusmir A, Salerno A. Postoperative infection after excisional toenail matrixectomy: a retrospective clinical audit. Journal of the American Podiatric Medical Association. 2011;101(4):316-22.