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MODIFIED SURGICAL REPAIR OF SEVERE INGROWN TOENAIL

Objective To summarize the effectiveness of modified surgical repair for severe ingrown toenail. Methods Between January 2005 and December 2010, 13 patients with severe ingrown toenail (16 toes) were treated. There were 12 males (15 toes) and 1 female (1 toe), aged 18-32 years with an average of 20 years. The disease duration was 1-15 years (mean, 2 years and 9 months). All affected toes were great toes. Ingrown toenail occurred bilaterally in 3 cases and unilaterally in 10 cases. Granulation tissue surrounding nail-edge, embedded toenail, and necrotic nail bed were completely removed; tension glue was used to make wound edge close to nail bed. Results At 3-5 days after operation, wound congestion, swelling, and exudation were improved; at 7 days, new nail bed formed; at 2 weeks, all wounds healed, and nail bed was epitheliogenic, wound edge healed well close to nail plate, and patients returned to normal life. At 6 months after nail extraction, new toenail grew and nail groove formed. No recurrent sign was found during 24-month follow-up. Conclusion Modified surgical repair is one of effective methods to treat severe ingrown toenail with the advantages of good appearance and low recurrent rate.

嵌甲的病因学探讨及疗效分析

探讨嵌甲的病因，分析手术治疗嵌甲的有效性。 方法 2000 年4 月－ 2005 年4 月，收治82例中、重度嵌甲患者。其中男48 例，女34 例；年龄14 ～ 25 岁，平均19.5 岁。均为口止母 趾发病，其中甲缘单侧44 例，双侧38 例。就诊前复发次数：初诊12 例，1 次复发者20 例，2 次复发者26 例，3 次及以上复发者24 例。术前口止母 趾外露甲体宽度患侧为（16.51 ± 0.27）mm，健侧为（16.56 ± 0.26）mm。手术将糜烂增生的甲皱襞、嵌入的趾甲及其下的甲床、嵌甲的甲根一并切除。 结果 82 例患者术后伤口愈合时间10 ～ 18 d，平均12.3 d。2 例伤口感染，经换药后愈合。68 例获随访3 个月～ 3 年6 个月，平均1 年4 个月，无1 例复发。术后随访功能评价，9 分以上62 例，占91.2%。从82 例患者中随机抽选20 例进行数据分析，术后口止母 趾外露甲体宽度患侧为（16.46 ± 0.27）mm，健侧为（16.56 ± 0.26）mm，与术前比较差异均无统计学意义（P gt; 0.05），外形满意。 结论 嵌甲的发生与不良修甲有关，正确选择术式不仅能根治嵌甲，而且可获得美观外形。

足母趾部分甲皱襞和甲床楔形切除治疗嵌甲

CLINICAL STUDY ON TREATMENT OF OBSTINATE INGROWN NAIL WITH DISTAL PHALANX OF GREAT TOE AND SOFT TISSUE ORTHOPAEDICS

Objective To investigate the clinical curative effect of distal phalanx of great toe and soft tissue orthopaedics for treatment of obstinateingrown nail. Methods From October 1997 to May 2006,31 patients(38 nails) suffering from obstinate ingrown nail were treated by the distal phalanx of great toe and soft tissue orthopaedics. There were 23 males(27 nails) and 8 females(11 nails) with an average age of 17.5 years(12-28 years). The disease course was 2years and 1 month to 14 years(average, 31-6 months). At the same time, thirty-eight patients with diseases of feet were selected randomly as controls. The depth of the nail groove was measured.The X-ray films were taken to calculate the rate of upward projection of tuberosity (r). Results Thedepth of the nail and r value of 31 patients were 2.87±0.31 mm and 0.149±0.013，respectively. There were statistically significant differences when compared with control group（1.06±0.10 mm and 0.060±0.019）（Plt;0.01）. Thirty patients(37 nails) had a primary healing; 1 patient(1 nail) had a delayed healing. Twenty-nine patients(36 nails) were followed up for 8 to 29 months(average, 21 months). The appearance of the nail was satisfactory. No relapse occurred in all patients. Conclusion The upward projection of tuberosity of distal phalanx of great toe and deepened nail groove are the most important anatomical causes for ingrown nail. The distal phalanx of great toe and soft tissue orthopaedics is aneffective treatment for obstinate ingrown nail.