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  • Proper Preop Makes for Easier Toenail Surgery
    April 15, 2007 • www.familypracticenews.com Skin Disorders 25 Proper Preop Makes for Easier Toenail Surgery BY JEFF EVANS sia using a digital block or a distal approach to take ef- Senior Writer fect. Premedication with NSAIDs, codeine, or dextro- propoxyphene also may be appropriate, he said. WASHINGTON — Proper early management of in- To cut away the offending section of nail, an English grown toenails may help to decrease the risk of recur- anvil nail splitter is inserted under the nail plate and the rence whether or not surgery is necessary, Dr. C. Ralph cut is made all the way to the proximal nail fold. The hy- Daniel III said at the annual meeting of the American pertrophic, granulated tissue should be cut away as well. Academy of Dermatology. Many ingrown toenails are recurrent, so Dr. Daniel per- “An ingrown nail is primarily acting as a foreign-body forms a chemical matricectomy in nearly all patients after reaction. That rigid spicule penetrates soft surrounding tis- making sure that the surgical field is dry and bloodless. sue” and produces swelling, granulation tissue, and some- The proximal nail fold can be flared back to expose more times a secondary infection, said Dr. Daniel of the de- of the proximal matrix if necessary. Dr. Daniel inserts a Cal- partments of dermatology at the University of Mississippi, giswab coated with 88% phenol or 10% sodium hydroxide Jackson, and the University of Alabama, Birmingham. and applies the chemical for 30 seconds to the portion of For the early management of stage I ingrown toenails the nail matrix that needs to be destroyed.
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    Nail Problems Components of the Nail Congenital Disorders Racket nails, characterized by a broad short thumb nail, is the commonest congenital nail defect, dominantly inherited and seen in 1% of the population. The basic abnormality is shortness of the underlying terminal phalanx. In the yellow nail syndrome, the nail changes begin in adult life, against a background of hypoplasia of the lymphatic system. Peripheral edema is usually present and pleural effusions may occur. The nails grow very slowly and become thickened and greenish-yellow; their surface is smooth but they are over curved from side to side. Acquired Nail Changes Beau's Lines Transverse lines or grooves in nail. Causes include any severe systemic illness or medications (chemotherapy), which affects growth of the nail matrix. Clinically: The grooves or lines move distally; the distance from the nail fold lets one assess the time of trauma. Onycholysis Separation of nail from nail bed. Causes include psoriasis, dermatitis, fungal infections; medications (photo-onycholysis from tetracyclines or psoralens), thyroid disease; rarely inherited. Idiopathic onycholysis is most common among women; painless separation of nail without apparent cause. Typically, the distal third separates and underlying nail bed becomes darker and thickened. Therapy: Cut nail very short to reduce leverage encouraging separation, apply antifungal solution. Usually self-limited process. Ingrown Nail Penetration of nail plate into tissue of lateral nail fold. Almost always involves great toes. Causes include congenital malformation of nail (pincer nail), improper trimming, and tightly fitting shoes. Clinically: Distorted nail with swelling, pain, and granulation tissue along the lateral nail fold. Therapy: Mild cases: Eliminate pressure, trim nail; topical antiseptics as foot soaks or on small piece of cotton wool pushed under affected nail.
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  • Proper Preop Makes for Easier Toenail Surgery
    20 Dermatologic Surgery S KIN & ALLERGY N EWS • April 2007 Proper Preop Makes for Easier Toenail Surgery BY JEFF EVANS produces swelling, granulation tissue, and tor or a 1- to 2-mm curette. has served as a speaker, consultant, and in- Senior Writer sometimes a secondary infection, said Dr. He also uses a technique for early-stage vestigator for the company. Daniel of the departments of dermatol- ingrown toenails in which dental floss is in- A procedure that uses an acrylic-affixed WASHINGTON — Proper early man- ogy at the University of Mississippi, Jack- serted under the ingrown nail corner with- gutter splint has been reported to be suc- agement of ingrown toenails may help to son, and the University of Alabama, Birm- out anesthesia and is kept there to separate cessful for avoiding surgery, Dr. Daniel decrease the risk of recurrence whether or ingham. the nail edge from adjacent soft tissue (J. said. A plastic gutter tube is set under the not surgery is necessary, Dr. C. Ralph For the early management of stage I in- Am. Acad. Dermatol. 2004;50:939-40). ingrown part of the nail and acrylic is Daniel III said at the annual meeting of the grown toenails in which some granula- Dr. Daniel formerly was on the board of sculpted and allowed to polymerize American Academy of Dermatology. tion tissue but no infection is present, Dr. directors for Doak Dermatologics, a sub- around the ingrown part of the nail and “An ingrown nail is primarily acting as Daniel has trained his nurse to push wisps sidiary of Bradley Pharmaceuticals Inc., hold the gutter tube in place.
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    POST-OP NAIL CARE The day following the procedure, remove the bandage and begin soaking the toe for 10-15 minutes at least once daily. If the bandage does not come off easily, soak in warm water with one (1) tablespoon Epson Salts. As you soak, use a cotton tipped applicator (Q-tip) to clean the nail groove. Also, gently pull the skin edges back from the area where the nail was removed to be sure that any draining is released. After drying the toes, apply a light amount of triple antibiotic ointment (Neosporin) or other topical anesthetic, and light gauze or a bandage (Band-aid). Gauze is best to absorb INGROWN drainage. After a few days, the toe may be Brian Gardner, D.P.M. TOENAILS overly moist and need to dry. Use less triple antibiotic, continue soaking, Podiatrist and dress with light gauze or a Dr. Brian Gardner specializes in bandage (Band-aid). As drying foot and ankle surgery, wound care, occurs, tenderness will usually biomechanics, sports medicine, decrease. Continue soaks until the diabetic foot care, area is no longer draining (usually and general foot care. several weeks, if the nail root was treated with a chemical). facebook.com/UintahBasinHealthcare www.ubh.org 435.725.2025, Roosevelt 435.781.2030, Vernal 250 W 300 N Clinic #2 Suite 203 (Level 2), Roosevelt, Utah 379 N 500 W, Vernal, Utah Nails grow from a root beneath the skin TREATMENT IMPORTANT called the “matrix.” This growth center TREATMENT INFORMATION can vary in size and shape. It may Initially, your doctor may be able to produce a nail which is flat, curved, trim the ingrown toenail.
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  • Procedural Review of Toenail Excision Scott Klosterman, DO, Candace Prince, OSM 4
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  • Ingrown Toenails: Digging out the Facts
    Ingrown toenails: digging out the facts The best method for treating patients with an The exact causes of ingrown toenails are still being ingrown toenail has long been debated. Non- debated surgical options are generally preferred for patients A number of intrinsic and extrinsic factors (see over page) have with mild-to-moderate symptoms, and surgical traditionally been linked with the development of ingrown toenails. However, there is a lack of quality evidence supporting options preferred in patients with more severe a single mechanism and ingrown toenail development may be symptoms. However, there is limited evidence triggered by multiple factors. There is ongoing debate about available regarding the effectiveness of non- whether factors relating to the nail itself are responsible for the surgical treatments. Recent evidence suggests that condition or whether the size and shape of the surrounding some surgical techniques are associated with very periungual nail folds are the cause (Figure 1).3 low recurrence rates of the ingrown toenail, and therefore should be considered more often, despite Lunula Proximal nail fold being a more invasive treatment. Lateral nail fold Distal edge of Ingrown toenails primarily affect younger Nail plate Eponychium males Nail plate The Foot Series Cuticle Ingrown toenails, also known as onychocryptosis or unguis incarnates, are a painful condition due to the sides or corner of the toenail digging into the surrounding soft tissue. This Nail plate Matrix results in a breach of the underlying skin and leads to pain, Nail bed inflammation, formation of granulation tissue, and in some cases infection. The most commonly affected area is the lateral Hyponychium edge of the great (big) toe, although the medial edge and other toes can also be affected.
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  • Results of the Mogensen's Lateral Wedge Resection Technique in The
    Eklem Hastalıkları ve Cerrahisi Joint Dis Rel Surg Joint Diseases and Related Surgery Original Article / Çalışma - Araştırma 2007;18(3):116-120 Results of the Mogensen’s lateral wedge resection technique in the treatment of ingrown toenail Ayak tırnak batmasının tedavisinde Mogensen’in lateral kama rezeksiyon tekniğinin sonuçları Ercan Çetinus, M.D.,1 Murat Uzel, M.D.,1 Erkal Bilgiç, M.D.,1 Sezai Şaşmaz, M.D.,2 Özer Arıcan, M.D.,2 Ahmet Karaoğuz, M.D.1 Departments of 1Orthopedics and Traumatology, and 2Dermatology, Medicine Faculty of Kahramanmaraş Sütçü İmam University Objectives: There are many options for the treatment Amaç: Ayak tırnak batmalarında basit konservatif yak- of ingrown toenail, ranging from simple conservative laşımlardan, kapsamlı cerrahi girişimlere kadar birçok approaches to extensive surgical procedures, but stage tedavi seçeneği olmakla birlikte, evre 3 tırnak batmaları 3 ingrown toenails are best treated surgically. The aim en iyi cerrahi olarak tedavi edilmektedir. Bu çalışmada, of this study was to evaluate the results of lateral wedge ayak başparmağında tırnak batması olan bir grup hasta- resection described by Mogensen in patients with ingrown da, Mogensen tarafından tarif edilen lateral kama rezek- toenail of the great toe. siyon tekniğinin sonuçları değerlendirildi. Patients and methods: The study included 21 con- Hastalar ve yöntemler: Ayak başparmağında evre 3 secutive patients (11 females, 10 males; mean age 23±10 tırnak batması nedeniyle 21 ardışık hasta (11 kadın, 10 years; range 12 to 45 years) who were treated with the erkek; ort. yaş 23±10; dağılım 12-45) Mogensen’in late- Mogensen’s lateral wedge resection technique for stage 3 ral kama rezeksiyon tekniği ile tedavi edildi.
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  • Minor Procedures
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