In-nail toe surgery treatment includes a number of different options. If conservative care of a nail that grows into a minor does not work or if the nail grows into a severe, surgical management is recommended by a podiatrist. The initial surgical approach is usually a partial avulsion of the nail plate known as slice resection or complete removal of toe nail. If the nail that grows into the reoccurs recurs despite this treatment, the destruction of the germinal matrix with phenol is recommended. Antibiotics are not required if surgery is performed.
Video Surgical treatment of ingrown toenails
Resection wedge
Partial removal of nails or offending nails. Here, the first digit is injected with a common local anesthetic. When the area is numb, the doctor will perform an onychectomy in which the nail along the edge that grows to the skin is ablated and the offended nail piece is pulled out. Each infection is dried by surgery. This process is referred to as a "wedge resection" or a simple and non permanent surgical ablation (ie the nail will grow back from the matrix). The entire procedure can be done at the doctor's office and takes about thirty to forty-five minutes depending on the extent of the problem. Patients are allowed to return home immediately and recovery time anywhere from two weeks to two months without complications such as infection. As a follow up, doctors may prescribe oral or topical antibiotics or special immersion to be used approximately a week after surgery. Some use "lateral inicoplasty" or "wedge resection" as the preferred method, for ingrown toenails. Wide wedge resection, with total nail matrix cleansing, has a success rate of nearly 100%. Some doctors will not perform complete nail avulsion (removal) except in the most extreme circumstances. In most cases, the doctor will lift both sides of the toenail (even if one side does not grow inside) and coat the nail matrix on both sides with a chemical or acid (usually phenol) to prevent regrowth. This keeps most of the nails intact, but ensures that growth problems will not re-occur. There is a possibility of a loss if the nail matrix is ​​not coated with chemical or acid (phenol) and allowed to grow back; this method is vulnerable to failure. Also, the underlying condition can still be a symptom when the nail grows for one year: the nail matrix may produce nails that are too curved, thick, wide or irregular to allow for normal growth. In addition, the meat can be hurt very easily by concussion, tight socks, quick twisting movements while walking or just the fact the nail grows wrong (maybe too wide). This hypersensitivity to advanced injuries can mean chronic growth; the solution is almost always the edge of avulsion by highly successful phenolatization.
Repetition
If the nail becomes grown again after a wedge resection, more invasive surgery may be performed, although this is a drastic measure that may not be necessary given the less invasive recurrent treatment. This can often include nail bedding destruction. This operation takes longer than the minor wedge resection. During that time, the tip of the toe will be folded and the incision will be made from the front of the foot to about 1 cm behind the rear of the visible nail. This incision is deep enough and will require stitching and also scarring. Nails will then be cut, such as wedge resection and damaged nails to prevent regrowth. The nails will be significantly narrower after this surgery and may appear very defective but will not grow anymore. Note: if doing this surgery it is advisable to leave at least four days before walking farther from a very short distance because even with these painkillers can be very painful. It is also important if you are asked by your employer to stand for long periods so they are aware that you may not be able to work for 1-2 weeks (at most) depending on your recovery speed.
Maps Surgical treatment of ingrown toenails
Avulsion procedure
In the case of recurrence despite complete removal, and if the patient has never felt pain before inflammation occurs, the condition is more likely to be onychia which is often confused for deep-growing or inwardly growing nails ( onychocryptosis ). The whole nail lifting is a simple procedure. Anesthesia is injected and the nail is removed rapidly by pulling it out of the toes. The patient can function normally after the procedure and most of the discomfort fades after a few days. The entire procedure can be done in about 20 minutes and less complex than the wedge resection above. The spikes will grow again. However, in many cases it will cause further problems as it can become very easy to grow as the nails grow outward. Can be easily hurt by concussion and in some cases grow back too thick, too wide or defective. This procedure can cause the nails to grow into chronic and is therefore considered a solution that does not work, especially considering the pain involved. Thus, in some cases as prescribed by the physician, the nail matrix is ​​coated with chemicals (usually phenol) so the nails will never grow back. This is known as a full or full nail avulsion, or full matrixectectomy, phenolation, or full phenol avulsion. As can be seen in the figure below, the less fingernails do not look like normal toes. Fake spikes or nail varnishes can still be applied to the area to provide a temporary normal appearance. In a small number of cases, phenolisation is unsuccessful and must be repeated, and podiatrist routinely warns the patient of this possible regeneration.
Vandenbos Procedures
The Vandenbos procedure was first described by Vandenbos KQ and Bowers WP in 1959 in the US Armed Forces Medical Journal. They reported to 55 patients and there was no recurrence. Next, Dr. Henry Chapeskie performed this procedure on more than 1,100 patients without recurrence since 1988. Unlike other procedures used to treat deep grown toenails, the Vandenbos procedure does not touch the nails. In this procedure, the legs involved are first anesthetized with a digital block and a tourniquet is applied. An incision is made proximal from the base of the nail about 5 mm (leaving the bottom of the nail intact) then extends to the side of the toe/foot in an elliptical sweep until it ends under the tip of the nail about 3-4 mm from the edge. It is important that all the skin on the edge of the nail is removed. Excision must leave frequent soft tissue deficiency of 1.5 Â ± 3.5 cm. Some of the lateral aspects of the distal phalanx are sometimes exposed without fear of infection. Antibiotics are not needed because the wound is left open to close with secondary intentions. Postoperative management involves soaking a toe in warm water 3 times/day for 15-20 minutes. The wound healed up to 4-6 weeks. No cases of osteomyelitis were reported. When healed, the skin of the nail fold remains low and firm on the side of the nail.
Syme procedure
In the case of difficult or recurrent Onychocryptosis (Ingrown Toenail), the patient's symptoms persist and he or she asks for a permanent surgical solution. The "Avulsion procedure" is a simple method, but the surgeon must be experienced for total destruction, or the removal of the nail matrix. The second loss is the long-term healing and recovery time (& gt; 2 months). In this case, the best method is the Syme procedure, which means total removal of nail matrix skin flap transfer falanx osteotomy partial seams.
Phenolization
After a local anesthetic injection at the base of the toe nail and possibly a tourniquet application, the surgeon will remove (blur) the tip of the nail into the flesh and destroy the matrix area with phenol permanently and selectively obscure the matrix that is making the growing inner part of the nail (ie , nail margins). This is known as a partial matrixectectomy, phenolation, phenol avulsion or partial nail avulsion with a phenolysis matrix. Also, each infection is dried by surgery. After this procedure, other suggestions about treatment after surgery will be performed, such as a saltwater bath from the toes. The essence of the procedure is that the nails do not grow back in place where the matrix has been burned so the chances of further growth are very low. Little nails (usually a millimeter or more) are narrower than before the procedure and barely visible a year later. This operation is advantageous because it can be performed in a doctor's office under local anesthesia with minimal pain after intervention. Also, no visible scars at the operating site and possible minor recurrences. Although the likelihood of recurrence of in-growing nails in areas that have undergone phenolisation is lower than the nails that have recently deepened deepened fingernails, if the application of phenol is not properly performed or the amount of inadequate phenol applied to the affected area; the nail matrix can regenerate from partial cautery and grow new nails. This will result in a recurrence of the nail that grows in about 4-6 months as the native grown skin grows also will recover from the procedure (but the recovery of the skin of both sides of the nail is the standard in this type of procedure) as well as the nail. Many patients who suffer from minor recurrences of ingrown toenails often have procedures performed again. However, some patients who experience more severe relapse will see a podiatrist who will perform the procedure again or use a more drastic and permanent solution (such as the entire nail removal or Vandenbos Procedure) if there is some recurrence of the ingrown toenail.
References
External links
- "Growing into toenails" Information on growing toe nails and a detailed description of Vandenbos procedures including images, research articles and video procedures
- "Nail Surgery" Chapter 33 of Textbooks from Hallux Valgus and Feet Operation, full text online in PDF files
- "Photos Complete Nail Operations Photos and comments that show a complete nail removal from start to finish.
Source of the article : Wikipedia
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