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Huang C, Huang R, Yu M, Guo W, Zhao Y, Li R, Zhu Z. Pincer Nail Deformity: Clinical Characteristics, Causes, and Managements. Biomed Res Int 2020; 2020:2939850. [PMID: 32382542 DOI: 10.1155/2020/2939850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/27/2020] [Indexed: 11/18/2022]
Abstract
A pincer nail is a common nail deformity of toenails and is characterized by nail thickening and nail plate deformation. It often causes severe pain for patients. We perform a thorough literature review and an additional review of pertinent clinical cases, aiming to provide a comprehensive review of the etiology, pathogenesis, clinical classification, differential diagnosis, and treatment of pincer nail deformity (PND). Understanding the clinical characteristics and treatment progress of a pincer nail will provide clinicians with comprehensive and evidence-based information about PND, thus allowing the selection of an appropriate treatment according to the patient's request and the clinical manifestations of PND, which should maximize patient satisfaction.
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Dikmen A, Ozer K, Ulusoy MG, Gursoy K, Koçer U. Triple Combination Therapy for Pincer Nail Deformity: Surgical Matricectomy, Thioglycolic Acid, and Anticonvex Sutures. Dermatol Surg 2017; 43:1474-82. [DOI: 10.1097/dss.0000000000001252] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gordon RI, Parashis AO, Tatakis DN. Extraoral Uses of Autologous Oral Soft Tissue Grafts: A Different Bridge Between Mouth and Body Health. Clin Adv Periodontics 2017; 7:215-220. [PMID: 31539215 DOI: 10.1902/cap.2017.160076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/20/2017] [Indexed: 11/13/2022]
Abstract
Focused Clinical Question: Are there any extraoral uses for intraoral soft tissue grafts? Summary: Despite extensive literature on the intraoral uses of soft tissue autografts harvested from oral sites, the periodontal literature is lacking information on the extraoral uses of such grafts. The purpose of this article is to review the autologous use of certain oral soft tissue grafts for extraoral indications. A literature search revealed that several medical specialties, including otolaryngology, ophthalmology, dermatology, plastic surgery, and urology, have a track record of positive outcomes with the use of free gingival, buccal fat pad, and buccal mucosa grafts for a wide variety of reconstructive procedures at diverse body sites. Conclusions: The numerous successful extraoral uses of oral soft tissue autografts underscore the versatility of these tissues in reconstructive surgery and suggest there is potential for collaboration between periodontal and medical specialists for the benefit of patients in need of such reconstructions. Broader awareness of these applications of oral soft tissue grafts could help expand their current uses and would allow practitioners to better answer possible patient inquiries.
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Affiliation(s)
- Ross I Gordon
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH
| | - Andreas O Parashis
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH.,Private practice, Athens, Greece
| | - Dimitris N Tatakis
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH
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Abstract
Background: Systemic lupus erythematosus (SLE) is an autoimmune disorder with various systemic and cutaneous manifestations. Nail abnormalities, including onycholysis, red lunulae, pitting, and ridging, have been seen in patients with the disorder. To our knowledge, however, pincer nail deformity has yet to be reported coincident with the onset of SLE. Objective: We report a case of pincer nail deformity subsequent to the development of SLE and describe surgical treatment of the deformed nails. This is followed by a review of the literature. Conclusion: Acquired pincer nail is a dystrophy with numerous reported causative associations, including psoriasis, tumors of the nail apparatus, tinea ungium, ß-blocker usage, and now SLE. Pain from the resulting constriction can interfere greatly with daily activities and can be debilitating to the extent of requiring therapy.
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Affiliation(s)
- Candace Majeski
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
| | - Bruce Ritchie
- Division of Clinical Hematology, University of Alberta, Edmonton, Alberta, Canada
| | - Martin Giuffre
- Division of Plastic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Gilles Lauzon
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
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Jung DJ, Kim JH, Lee HY, Kim DC, Lee SI, Kim TY. Anatomical Characteristics and Surgical Treatments of Pincer Nail Deformity. Arch Plast Surg 2015; 42:207. [PMID: 25798393 PMCID: PMC4366703 DOI: 10.5999/aps.2015.42.2.207] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 12/04/2014] [Accepted: 12/23/2014] [Indexed: 11/08/2022] Open
Abstract
Background Pincer nail deformity is a transverse overcurvature of the nail. This study aimed to define the anatomical characteristics of pincer nail deformity and to evaluate the surgical outcomes. Methods A retrospective review was conducted on 20 cases of pincer nail deformity of the great toe. Thirty subjects without pincer nail deformity or history of trauma of the feet were selected as the control group. Width and height indices were calculated, and interphalangeal angles and base widths of the distal phalanx were measured with radiography. We chose the surgical treatment methods considering perfusion-related factors such as age, diabetes mellitus, kidney disease, and peripheral vascular disease. The zigzag nail bed flap method (n=9) and the inverted T incision method (n=11) were used to repair deformities. The outcomes were evaluated 6 months after surgery. Results The interphalangeal angle was significantly greater in the preoperative patient group (14.0°±3.6°) than in the control group (7.9°±3.0°) (P<0.05). The postoperative width and height indices were very close to the measurements in the control group, and most patients were satisfied with the outcomes. Conclusions We believe that the width and height indices are useful for evaluating the deformity and outcomes of surgical treatments. We used two different surgical methods for the two patient groups with respect to the perfusion-related factors and found that the outcomes were all satisfactory. Consequently, we recommend taking into consideration the circulatory condition of the foot when deciding upon the surgical method for pincer nail deformity.
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Ghaffarpour G, Faghihi A, Ghasemi M, Ghaffarpour G. Nail bed expansion: A new technique for correction of multiple isolated congenital micronychia. Adv Biomed Res 2014; 3:105. [PMID: 24804179 PMCID: PMC4009749 DOI: 10.4103/2277-9175.129698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 03/12/2014] [Indexed: 11/04/2022] Open
Abstract
Congenital micronychia may involve big toes or may involve other nails. The etiology of micronychia is not clear but amniotic bands, teratogens (drugs, alcohol), Nail Patella Syndrome etc. A 44-year-old woman with multiple isolated congenital micronychia over her hands and feet was selected. The major affected nails were thumbs and Index fingers. Surgical method were done step by step: Anesthesia of the area, extraction of short nail, elevation of nail bed, longitudinal nail bed incisions, suturing the lateral nail bed to the nail wall, covering the nail bed by a splint of plastic suction tube, bandage with gauze Vaseline. Finally, we hypnotized that in congenital micronychia, the main pathology is in nail bed; through this theory by nail bed expansion better outcomes are coming.
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Affiliation(s)
- Gholamhossein Ghaffarpour
- Skin and Stem Cell Research Center, Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Faghihi
- Skin Diseases and Leishmaniasis Research Center, Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran, Department of Dermatology, Rasoul-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Ghasemi
- Department of Dermatology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Gelareh Ghaffarpour
- Skin and Stem Cell Research Center, Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran ; Skin Diseases and Leishmaniasis Research Center, Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran, Department of Dermatology, Rasoul-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Sano H, Ogawa R. Clinical Evidence for the Relationship between Nail Configuration and Mechanical Forces. Plast Reconstr Surg Glob Open 2014; 2:e115. [PMID: 25289309 DOI: 10.1097/GOX.0000000000000057] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 01/02/2014] [Indexed: 11/27/2022]
Abstract
Summary: Mechanobiology is an emerging field of science that focuses on the way physical forces and changes in cell or tissue mechanics contribute to development, physiology, and disease. As nails are always exposed to physical stimulation, mechanical forces may have a particularly pronounced effect on nail configuration and could be involved in the development of nail deformities. However, the role of mechanobiology in nail configuration and deformities has rarely been assessed. This review describes what is currently understood regarding the effect of mechanical force on nail configuration and deformities. On the basis of these observations, we hypothesize that nails have an automatic curvature function that allows them to adapt to the daily upward mechanical forces. Under normal conditions, the upward daily mechanical force and the automatic curvature force are well balanced. However, an imbalance between these 2 forces may cause nail deformation. For example, pincer nails may be caused by the absence of upward mechanical forces or a genetic propensity increase in the automatic curvature force, whereas koilonychias may occur when the upward mechanical force exceeds the automatic curvature force, thereby causing the nail to curve outward. This hypothesis is a new concept that could aid the development of innovative methods to prevent and treat nail deformities.
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Tseng JTP, Ho WT, Hsu CH, Lin MH, Li CN, Lee WR. A Simple Therapeutic Approach to Pincer Nail Deformity Using a Memory Alloy: Measurement of Response. Dermatol Surg 2013; 39:398-405. [DOI: 10.1111/dsu.12094] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nam HM, Kim UK, Park SD, Kim JH, Park K. Correction of pincer nail deformity using dermal grafting. Ann Dermatol 2012; 23:S299-302. [PMID: 22346262 PMCID: PMC3276781 DOI: 10.5021/ad.2011.23.s3.s299] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 12/15/2010] [Accepted: 12/15/2010] [Indexed: 11/18/2022] Open
Abstract
Pincer nail deformity is characterized by excessive curvature and distortion of the nail in the transverse dimension, and particularly at the distal part of the nail plate. This deformity leads to pinching off and loss of soft tissue in the affected digit, causing severe pain. Many treatment methods have been proposed; however, an effective long-term method preserving the nail matrix has not yet been established. We present here a case of pincer nail in the left thumb in a 49-year-old woman who was treated successfully with dermal grafting under the nail bed. We describe the surgical method and the treatment results. To the best of our knowledge, this is the first report in the Korean medical literature on the use of dermal grafting for the treatment of pincer nail deformity.
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Affiliation(s)
- Hyun Min Nam
- Department of Dermatology, Wonkwang University School of Medicine, Iksan, Korea
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Abstract
BACKGROUND In instances of pincer nail deformity, patients complain of pain associated with walking, wearing shoes, or light touching. Cosmetic concerns and difficulties in terms of nail clipping also arise. Achievement of a satisfactory nail form remains elusive. OBJECTIVE To introduce our original surgical procedure and present the satisfactory results. MATERIALS & METHODS The zigzag nail bed flap method was used on 71 toenails in 49 patients displaying pincer nails (11 male, 38 female; age range 12-88, mean, 48.6). This investigation evaluated 70 nails from the great toe and one nail from a second toe. RESULTS No postoperative complications, including pain, infection and conspicuous scars, were evident. The degree of improvement was determined objectively with the width and height indices, revealing the accuracy of this therapeutic measure. CONCLUSION The authors recommend surgical intervention consequent to the vicious cycle corresponding to anatomical abnormalities associated with the nail plate-nail bed-phalanges relationship. Therefore, these architectures should be treated in conjunction rather than singularly.
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Affiliation(s)
- Masaaki Kosaka
- Department of Plastic and Reconstructive Surgery, Kinki University School of Medicine, Osakasayama City, Osaka, Japan.
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Tanaka A, Hatoko M, Tada H, Yurugi S, Iioka H, Niitsuma K. Histological evaluation of grafted hard palate mucosa in the reconstruction of the upper eyelid. ACTA ACUST UNITED AC 2009; 39:376-8. [PMID: 16298812 DOI: 10.1080/0284431051006358] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We have used a hard palate mucosal graft for reconstruction of the posterior lamella of the eyelid and in only one case was replacement required because of discomfort and pain. The stratum corneum of the hard palate mucosa may have been the cause.
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Affiliation(s)
- Aya Tanaka
- Division of Plastic Surgery, Nara Medical University, Kashihara, Nara, Japan.
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Abstract
BACKGROUND Pincer nail is a rare deformity characterized by transverse overcurvature of the nail that increases distally. Many conservative and surgical treatment modalities have been recommended, but there is not a worldwide accepted technique for long lasting treatment of this deformity yet. PURPOSE A new surgical technique for the treatment of pincer nail deformity is described. MATERIAL AND METHOD In this procedure, after the osteophyte located on the dorsal surface of the distal phalanx is removed to provide a flat surface for the nail bed, the distal part of the nail bed is enlarged in a transverse direction by using a modified 5-flap z-plasty technique. Over 2 years, this technique has been performed on 15 toes in 8 patients. RESULTS In all patients, the deformity was eliminated successfully with no recurrence in 2 years of follow up. The growing nail turned back into its natural form and all clinical signs and symptoms of the pincer nail deformity were relieved. CONCLUSIONS Widening and flattening the nail bed provide a longlasting effective treatment of the pincer nail deformity with an excellent esthetic result. Pain and episodes of infection is relieved perfectly with this new technique.
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Affiliation(s)
- Mehmet Mutaf
- Department of Plastic and Reconstructive Surgery, Gaziantep University School of Medicine, Gaziantep, Turkey.
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Affiliation(s)
- Scott T VanDuzer
- Philadelphia Hand Center, Drexel University School of Medicine, Thomas Jefferson University School of Medicine, Philadelphia, PA 19107, USA
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Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is an autoimmune disorder with various systemic and cutaneous manifestations. Nail abnormalities, including onycholysis, red lunulae, pitting, and ridging, have been seen in patients with the disorder. To our knowledge, however, pincer nail deformity has yet to be reported coincident with the onset of SLE. OBJECTIVE We report a case of pincer nail deformity subsequent to the development of SLE and describe surgical treatment of the deformed nails. This is followed by a review of the literature. CONCLUSION Acquired pincer nail is a dystrophy with numerous reported causative associations, including psoriasis, tumors of the nail apparatus, tinea ungium, ss-blocker usage, and now SLE. Pain from the resulting constriction can interfere greatly with daily activities and can be debilitating to the extent of requiring therapy.
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Affiliation(s)
- Candace Majeski
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
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Abstract
BACKGROUND To treat pincer nail, both conservative therapy and surgical therapy have been reported. However, there is no consensus about the best method of treatment. OBJECTIVE The use of a splint prepared from an aspiration tube after pincer nail surgery is introduced. METHODS Pincer nail was treated by surgery with splinting in seven patients (nine toes). RESULTS Nine toes from seven patients were evaluated. The postoperative follow-up period ranged from 6 to 37 months (mean 17.7 months). An excellent result was obtained in eight toes, but ingrowth of the nail occurred in one toe. The cosmetic improvement was marked and satisfactory. CONCLUSION This splint is cheap and easy to make, can prevent contracture of the nail matrix and nail bed, can reduce pain, and allows direct observation of the nail bed because it is transparent. Thus, this technique seems to be convenient and useful.
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Affiliation(s)
- Toshiyuki Ozawa
- Department of Plastic and Reconstructive Surgery, Osaka City University, Graduate School of Medicine, Abeno, Osaka, Japan.
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