Quality of life improvement in aged patients after toenail surgery

[Ingrown toenail: when and how to treat?]

With an estimated prevalence of 2.5-5% of the western population, ingrown toenails are one of the most common nail diseases that leads patients to general physicians as well as to dermatological or surgical clinics. The cause of the disease is multifactorial, including genetic predisposition with a too wide nail plate, but also incorrect cutting of the nail and wearing of too tight shoes. Penetration of the sharp, lateral edge of the nail plate into the tissue results in inflammatory irritation of the lateral nail wall. The extent of the inflammation does not necessarily correlate with subjective symptoms, so that patients may describe severe pain even with low levels of inflammation. The big toe is most frequently affected. Several treatment approaches are available. Podiatric treatment such as tamponades or sulci protectors can improve the symptoms in mild cases. Surgical treatment primarily involves chemical matrixectomy (e.g., using phenol) or mechanical resection of the lateral matrix horn. The use of traumatic surgical techniques such as the so-called "Emmert plasty" or wedge excisions is not recommended.

Influence of the kinesiophobia and its pain intensity relationship in subjects with onychocryptosis

Background

Onychocryptosis is a nail deformity that occurs when the side of the nail grows into soft tissue, which causes pain, sepsis and the formation of granulation. The aim of the study was to evaluate and compare different levels of kinesiophobia in subjects with onychocryptosis before and after surgery to eliminate this condition.

Methods

A descriptive and observational study was conducted with a total sample size of 25 subjects with a mean age of 40.96 ± 18.25 years. The pretest sample was composed of the 25 subjects before the surgical treatment of onychocryptosis and the posttest sample was composed of the same 25 subjects after the surgical treatment of onychocryptosis. Kinesiophobia levels and total scores were self-reported using the Spanish version of the Tampa Scale for Kinesiophobia (TSK-11).

Results

The Wilcoxon test for related samples and the Mann-Whitney U test for independent samples were used to compare the results before and after the surgical treatment. It was observed that in all the items as well as in the total score, there were significant changes in the levels of kinesiophobia, after the surgical intervention for onychocryptosis (P < 0.05) compared to the levels before surgery, except for items 4 and 11 in which there were no significant differences (P > 0.05). Before surgery, 0% of the subjects with onychocryptosis reported not being afraid of movement, 16% reported mild fear of movement, 8% reported moderate fear of movement and 76% of the subjects with onychocryptosis reported severe and maximum fear of movement. On the other hand, 100% of the subjects did not report kinesiophobia after surgical treatment (P < 0.01).

Conclusions

The levels of kinesiophobia were higher in the subjects with onychocryptosis compared to the subjects after having undergone surgery to eliminate onychocryptosis.

Total Chemical Matricectomy With 88% Phenol: A Prospective Case Series of 37 Patients

BACKGROUND

Definitive nail dystrophies, congenital, traumatic, or acquired, affecting mainly elderly patients, may not be sufficiently managed with a periodic conservative treatment. A definitive surgical treatment may be considered an alternative method, especially in symptomatic patients.

OBJECTIVE

To evaluate the effectiveness of total matricectomy with 88% phenol solution to treat some nail dystrophies, not otherwise satisfactorily managed.

METHODS

A series of 48 surgeries were performed on 37 patients. Pain evaluation, interference with shoes and gait, recurrences, and patients' satisfaction with procedure were evaluated.

RESULTS

All patients mentioned some pain or impairment in wearing shoes before surgery. Cosmetic results were remarkable, and most of the patients (95.11%) had a dramatic improvement of their discomfort after the procedure. No severe complications occurred during the 12-month follow-up.

LIMITATIONS

Single-center study and the limited number of patients.

CONCLUSION

Total matricectomy with 88% phenol solution is an effective surgical method with low rates of postoperative morbidity and high success rates for treating symptomatic nail dystrophies. The satisfaction with the cosmetic results is high, and this is a safe procedure for patients with associated comorbidities.

Telefonische Verlaufskontrolle nach ambulanten nagelchirurgischen Eingriffen – eine retrospektive Analyse

Hintergrund

Zu den Versorgungsgebieten der Dermatochirurgie gehört die operative Behandlung von Erkrankungen des Nagelorgans. Untersucht wurden Beschwerden und Nebenwirkungen nach Nageleingriffen mittels telefonischer Verlaufskontrolle (TFU) und deren Eignung für die postoperative Kontrolle und Beratung.

Patienten und Methodik

Alle Patienten, die von Oktober 2019 bis Dezember 2021 in der Hautklinik am Klinikum der Stadt Ludwigshafen am Rhein ambulant am Nagelorgan operiert wurden, wurden am zweiten bis dritten postoperativen Tag telefonisch kontaktiert und standardisiert zu postoperativen Beschwerden befragt.

Ergebnisse

Insgesamt wurden 100 Fälle nachverfolgt. Die am häufigsten durchgeführten Eingriffe waren Phenolkaustik (41%), Nagelavulsion (16%) und Nagelmatrixbiopsien (9%). 50% und 21% der Patienten berichteten jeweils am Tag des Eingriffs und am Folgetag Schmerzen gehabt zu haben. Nach Nagelavulsion wurden signifikant häufiger Schmerzen am Folgetag nach dem Eingriff berichtet und Schmerzmittel benötigt (p  =  0,002). Schwerwiegende Nebenwirkungen traten nicht auf. Zehn Prozent der Befragten äußerten bei der TFU konkrete Fragen und benötigten eine Beratung.

Schlussfolgerungen

Alle Nageleingriffe wurden gut vertragen. Schmerzen stellten die häufigsten Beschwerden dar, allerdings gab nur die Hälfte aller Angerufenen an, am Operationstag Schmerzen gehabt zu haben, am Folgetag nur noch 21%. Die TFU stellt eine effektive, praktikable sowie einfach zu etablierende Methode zur postoperativen Verlaufskontrolle und Beratung nach ambulanten Nageleingriffen dar.

Telephone follow-up after outpatient nail surgery - a retrospective analysis

BACKGROUND

One of the areas of care in dermatosurgery is the surgical treatment of diseases of the nail organ. Side effects and complications after nail surgery were investigated by telephone follow-up (TFU), and its suitability for postoperative monitoring and consultation was assessed.

PATIENTS AND METHODS

All patients who underwent nail surgery at the Department of Dermatology at the Ludwigshafen City Hospital from October 2019 to December 2021 in outpatient setting were contacted by telephone on the second to third postoperative day and questioned in a standardized manner about postoperative complaints and counselled if necessary.

RESULTS

A total of 100 cases were followed up. The most common procedures performed were phenol matricectomy (41%), nail avulsion (16%), and nail matrix biopsies (9%). 50% and 21% of patients reported pain on the day of the procedure and the day after surgery, respectively. After nail avulsion, pain was statistically significantly more frequently reported on the day following the procedure and pain medication was statistically significantly more frequently required (p  =  0.002). Serious adverse events did not occur after nail surgery. 10% of the respondents raised specific questions and needed counseling by TFU.

CONCLUSIONS

All nail surgeries were well tolerated in the outpatient setting. Pain was the most common side effect, although only half of all patients reported pain on the day of surgery and only 21% on the day after the procedure. The TFU proved to be an effective and practical as well as easy to establish method for postoperative follow-up and consultation after outpatient nail surgery.

The therapeutic outcomes of one-minute application of sodium hydroxide versus phenol in the chemical cauterization of ingrown toenails

BACKGROUND

Ingrown nails are frequently encountered in dermatology practice. The recurrence tendency of the disorder makes chemical cauterization essential during surgical procedures. In studies comparing nail matrix cauterization with sodium hydroxide (NaOH) versus phenol, phenol's application time was highly variable.

OBJECTIVE

To compare the therapeutic outcomes of matrix cauterization for a standard duration of one minute for NaOH versus phenol in stage II and III ingrown nails MATERIAL AND METHODS: The medical records of patients undergoing matrix cauterization with 10% NaOH or 88% phenol were evaluated. The primary outcome measure was the lack of recurrences on long-term follow-up. The secondary outcome measures were complete healing duration, patient-reported pain scores, and adverse effects related to the procedure.

RESULTS

Enrolled in this study were 62 ingrown toenail sides treated with 10% NaOH and 56 ingrown toenail sides treated with 88% phenol. The mean follow-up duration was 25.17 months. Recurrence was observed in four nail sides of the NaOH group (%6.45) and three nail sides of the phenol group (%5.35). The difference between the recurrence rates did not reach statistical significance. Patients treated with both methods were free of pain on the post-procedural tenth day. The visual analog scale pain scores and complete healing duration were similar between the two groups (p>0.05).

CONCLUSION

In a large group with long-term follow-up results, the short-term and long-term post-operative treatment outcomes were similar between the one-minute applications of 10% NaOH versus 88% phenol groups.

Patient Satisfaction with Treatment for Onychocryptosis: A Systematic Review

Onychocryptosis, or ingrown nail, is a common condition in which the nail plate penetrates the nail fold, often resulting in inflammation and pain. Nonsurgical and surgical treatments are utilized, but patient satisfaction with these therapies has not been well studied. The purpose of this study was to systematically review the available literature describing patient-reported outcomes of onychocryptosis treatments. We performed a search of the literature published prior to May 22, 2019. Articles were included in the review if primary data were presented, patient-reported outcome measures (PROMs) were used, and nail involvement was specifically examined. From the initial search, 18 studies were included in the final analysis. Patients receiving both nonsurgical and surgical interventions reported high levels of overall satisfaction; however, most studies used ad hoc measures rather than validated PROMs, providing little granular information on the impact of treatment on quality of life (QoL). This review affirms that treatment for onychocryptosis results in satisfactory outcomes for patients; however, increased efforts are needed to understand the impact of therapy on patient QoL as assessed by validated outcome measure that accurately assess patients' cosmetic, physical, and social difficulties.

Recurrence and satisfaction with sutured surgical treatment of an ingrown toenail

BACKGROUND

In the present study, we investigated the satisfaction of patients following sutured surgical treatment of an ingrown toenail with nail preservation and without matricectomy.

MATERIALS AND METHODS

This study was retrospective. In total, 37 consecutive patients underwent 54 ingrown toenail surgeries. The clinical outcomes, satisfaction of surgery, recurrence rates and the duration of symptoms were compared.

RESULTS

Recurrence with the technique was very low (one toenail). The mean overall satisfaction score on the surgical satisfaction questionnaire was 86.4 ± 10.4 and extended with a modified esthetic subscale (88 ± 10). The mean pain subscale score was the lowest at 77.1 ± 16.8, while the subscale returns to baseline scored 80.9 ± 16.4, the subscale global satisfaction scored 98.1 ± 7.2 and the subscale esthetics scored 92.1 ± 15.

CONCLUSION

Our suturing technique was associated with low recurrence and high satisfaction rates. We showed that higher levels of satisfaction with the treatment were achieved in men, and the duration of symptoms was no longer than one year.

Effectiveness of Leukocyte and Platelet-Rich Fibrin versus Nitrofurazone on Nail Post-Surgery Bleeding and Wound Cicatrization Period Reductions: A Randomized Single Blinded Clinical Trial

Background: Leukocyte and platelet-rich fibrin (L-PRF) may be considered a co-adjuvant intervention that may play a key role in blood coagulation and tissue repair after nail surgeries. The aim of this study was to determine the effectiveness of L-PRF versus nitrofurazone on the post-surgical bleeding and wound cicatrization period in patients with bilateral onychocryptosis during surgeries of chemical matrixectomies with 88% phenol solution. Methods: A randomized single-blind clinical trial was registered with the European Clinical Trials Database (EudraCT) with identification number 2016-002048-18. Twenty healthy participants with bilateral onychocryptosis (n = 40) were recruited and bilaterally received both protocols for both halluces. Patients with a mean age mean of 45.55 ± 12.19 years attended a specialized foot and ankle surgery clinic. Both halluces of each patient were randomized and allocated to receive L-PRF (experimental group; n = 20 halluces) or nitrofurazone (control group; n = 20 halluces) interventions in conjunction with surgery of chemical matrixectomies with 88% phenol solution for bilateral ingrown of toenail border (medial and lateral). Patients were blinded to their intervention in each hallux. The primary outcome measurement was post-surgical bleeding. The secondary outcome measurements were post-surgical pain intensity, inflammation, infection, analgesic intake, and wound cicatrization period. Results: Statistically significant differences (p < 0.001) were found between both groups showing a reduction for wound cicatrization period and post-surgical bleeding for the L-PRF intervention with respect to nitrofurazone treatment. The rest of the outcome measurements did not show any statistically significant differences (p > 0.05). Conclusions: L-PRF rather than nitrofurazone in conjunction with chemical matrixectomies performed with 88% phenol solution reduced the wound cicatrization period and bleeding after nail surgery. Thus, L-PRF may be considered a first-line co-adjuvant intervention for patients who suffer from nail problems, such as onychocryptosis, that require surgical procedures.