Spiculectomy and Orthonyxia for Ingrown Toenails in Patients at Risk; Prospective Observational Cohort Study

Background: Ingrown toenails (unguis incarnatus) are common in persons with Diabetes Mellitus (DM) and Peripheral Arterial Disease (PAD). Minimal invasive treatment of ingrown toenails with spiculectomy and/or orthonyxia might be a promising treatment option. Aim: The aim of this study was to evaluate the efficacy and safety of minimal invasive treatment spiculectomy and orthonyxia Design/Setting: Prospective observational cohort study in an outpatient podiatric clinic Method: Eighty-eight patients with unguis incarnatus were included. Primary outcomes were post-procedural complication rate (infection and hemorrhage), and duration of pain. Patient satisfaction during and after treatment procedure was evaluated. Results: Healing was achieved in 80/88 (90.9%) persons; non-DM group 28/32 (87.5%) vs DM group 51/56 (91.1%); median healing time (21 [14, 42] days) and median treatment time; (56 [30, 86] days) were comparable between the non-DM and the DM groups. (Sixty-four patients (72.7%) had a significant pain reduction within 0-2 days. Median reduction of the VAS score after the first treatment was 2.0 points [0.0, 6.0] (non-DM group 3.5[1.0, 6.0]; DM group 2.0[0.0, 5.0] (p=0.0117)). Forty-eight (94, 4%) patients, 31(96.9%) non-DM group vs 53(94.6%) DM group (p=0.534)) had no limitations in daily activities by the affected toe after 14 days. There were no treatment-related complications like bleeding or infection. Conclusion: Spiculectomy and orthonyxia resulted in a high patient satisfaction. Five of 88 patients needed referral for a partial nail resection. This treatment seems to be very suiTable for persons with a high risk for foot ulcerations.

Unguis incarnatus – konservative oder operative Therapie? Ein praktischer Behandlungsalgorithmus

Zusammenfassung Der Unguis incarnatus ist ein häufiges Krankheitsbild, mit dem sich Patienten in der Hausarztpraxis, der dermatologischen Klinik oder der chirurgischen Notaufnahme vorstellen. Häufig führt die inkonsequente konservative Therapie oder die falsch-indizierte operative Intervention zu langwierigen und komplikationsreichen Verläufen, inklusive Rezidiven. Die Patienten sollten über die Komplexität des Nagelorgans aufgeklärt werden, um der Banalisierung der Erkrankung vorzubeugen, und eine entsprechende Compliance in der Therapie zu erreichen. In diesem Manuskript wird die sachgerechte Versorgung des Unguis incarnatus im Sinne eines praktischen Behandlungsalgorithmus dargestellt. Die konsequente konservative Therapie ist bei akutem Unguis incarnatus mit milder Ausprägung die Therapie der ersten Wahl mit guten Behandlungsergebnissen. Nagelerhaltende operative Eingriffe kommen bei moderaten/schweren akuten Formen zum Einsatz. Der chronische Unguis incarnatus, ohne floride Infektion, stellt eine elektive Operationsindikation dar. Sowohl bei den nagelerhaltenden Eingriffen als auch bei erweiterten operativen Maßnahmen ist eine chirurgische Operationsaufklärung obligat.

Der Unguis incarnatus

Zusammenfassung. Der eingewachsene Grosszehennagel ist eine der häufigsten Fusserkrankungen in der hausärztlichen Praxis. Ein falsch oder nicht behandelter Unguis incarnatus führt oft zu einem unnötig langen Leidensweg mit negativen Auswirkungen auf den Alltag der Patienten. Bis heute gibt es keinen Goldstandard in der Behandlung und ein chirurgisches Verfahren ist meist die allerletzte Option. Ein Grund mag die grosse Auswahl an konservativen und chirurgischen Behandlungsmöglichkeiten sein, ein anderer, die hohe Rezidivrate (bis > 30 %) nach chirurgischen Verfahren. Wir sind der Meinung, dass diese hohe Rezidivrate womöglich Ausdruck fehlerhaft durchgeführter Eingriffe ist. In diesem Artikel werden wir schrittweise die minimal-invasive partielle Nagelavulsion mit partieller Matrixektomie darstellen, welche wir seit Jahren in unserer Klinik durchführen. Unsere Erfahrung zeigt, dass diese Methode sehr gute funktionelle, kosmetische und rezidivfreie Langzeitresultate aufweist.

CHRONIC MYCOTIC-ASSOCIATED SURGICAL NAIL PATHOLOGY COMPLICATED WITH INGROWN NAIL (NAIL INCARNATION): THE ANALYSES OF CLINICAL CASES AND COMPLEX TREATMENT

Background. Conservative treatment of secondary recurrent unguis incarnatus are not very effective and Dupuytren’s method, Emmert-Schmiden surgeries etc. are very traumatic, disfigure nail bone, distort anatomic and functional unity of a nail.Objective. The aim of our research was the optimal sequence of holiatry, surgical moving away from nails, local and system therapy after excision of the staggered nails in case of destructive onychomycosis complicated by secondary ingrown nail for some patients with complicated mycotic defeat of nails. Clinical options of surgical treatment were clarified; morphologic changes were studied; causes of unsatisfactory outcomes of chronic pathology complex treatment were analyzed for prospective approaches to preventing of relapses.Methods. The analysis justifies the feasibility of establishing of predictive relationships between clinical variants of chronic purulent necrotic infections and combined comorbidity. System therapy by itraconazole before operative treatment (basic onychial defeats sanation) and in a postoperative period was carried out. Types of operative treatment applied may be divided into five statistic groups.Results. Over a five-year period (2010-2015) 436 unguis incarnates diagnosis (325 cases of incarnated onychomycosis) in 259 men and 177 women aged 12-67 were performed, 38 of them with incarnated onychogryphosis had diabetes mellitus and 24 had metabolic syndrome. Analysis of subonychial scraping allowed stating the prevalence of red trichophytia in 31% of cases with the bacterial flora. Patients with combined pathology got 4-5 five-day system ‘pulses’ of 400 mg/day itraconazole therapy. In patients with primary advantage of providing low-impact methods of nail excision with access via onycholisation structure a nail extirpation and marginal matricectomy was carried out; dermatophytoms and stratification on a nail bed were deleted.Conclusions. Type of onychectomy wound cytograms in the study group on the 10th day was defined as regenerative-inflammatory in 24.81%, regeneratory in 75.19% (p=0.031). The methods of surgical treatment of mycotical recurrent nail incarnation have been improved considering patho- and morphogenetic properties of destructive onychomycosis.