B e s t Way to Tre a t a n I n grown Toenail Nilton Di Chiacchio, MD, PhDa,*, Nilton Gioia Di Chiacchio, MDa,b KEYWORDS Ingrown toenail Toe Toenail procedures Nail phenolization Nail plate Debulking Nail hypertrophy
KEY POINTS Nail phenolization is considered a useful procedure for treating ingrowing toenails. Nail phenolization is indicated when partial and definitive removal of the nail plate is necessary. Nail phenolization is simple and inexpensive, and associated with little postoperative discomfort, a quick return to normal activities, and a low rate of complication and recurrence. The Howard-Dubois and super U techniques are indicated when ingrowing nails are caused by hypertrophy of nail folds, according to the degree of severity. The Howard-Dubois and super U techniques produce very good results, although the healing time and time until return to normal activities are longer with the super U technique.
NARROWING OF THE NAIL PLATE Nail phenolization is the best technique for definitive narrowing of the nail plate.7 It is well indicated in patients with diabetes and those using anticoagulants.8 Patients should be advised about the postoperative oozing and inflammatory process of proximal and lateral nail folds, and normal daily activities. Nail phenolization is considered easy to perform, but specialized training is required. After cleaning the involved digit with alcohol 70%, a tourniquet is applied and distal block anesthesia with lidocaine 2% without epinephrine is administered. When granulation tissue is present, it should be curetted to enable a better view of the nail plate to avoid excessive nail plate removal. The lateral involved nail plate is detached from the nail bed and the lateral and proximal nail folds (z3– 5 mm). The nail plate is split using a scissors or nail nippers from the free edge to the matrix and removed using a hemostat in a rotation motion.
a Dermatologic Clinic, Hospital do Servidor Pu´blico Municipal de Sa˜o Paulo, Sa˜o Paulo, Brazil; b Department of Dermatology, Medical School of ABC, Sa˜o Paulo, Brazil * Corresponding author. Rua Machado Pedrosa, 370, Sao Paulo 02045010, Brazil. E-mail address: [email protected]
Dermatol Clin - (2015) -–http://dx.doi.org/10.1016/j.det.2014.12.009 0733-8635/15/$ – see front matter Ó 2015 Elsevier Inc. All rights reserved.
derm.theclinics.com
An ingrown toenail is a common problem that causes significant morbidity and disability in daily life. An imbalance between the widths of the nail plate and the nail bed and the hypertrophy of nail folds are considered to be the causes.1 A large number of articles on the conservative treatment of ingrowing toenails have been described.2–6 Techniques such as massaging the nail folds, taping, gutter splinting, and orthesis may help in the treatment of ingrowing nails, especially in mild cases and in children. These treatments are lengthy and, when they are not well indicated, recurrence rates are considered high.7 Surgical treatment is indicated either when conservative treatments have failed or in moderate and severe cases.1 For cases in which nail is responsible for the ingrown toenail, the definitive narrowing of the nail plate is preferred. When the condition is caused by hypertrophy of nail folds, debulking of the periungueal soft tissues is performed.1 This article describes the best surgical treatment of ingrowing toenails.
2
Di Chiacchio & Di Chiacchio When necessary, the nail matrix, nail bed, and lateral nail fold are gently curetted to remove debris. A cotton swab is moistened with phenol solution 88% and applied to the lateral sulcus under the proximal fold and rubbed vigorously onto the matrix for 1 minute (Fig. 1).9
Management of Complications Oozing appears on the third day and may continue for up to 3 weeks. This oozing is improved by frequent washing of the wound, at least twice a day.9 A 20% ferric chloride solution can be used just after phenolization to improve postoperative drainage.10 Slight edema in the lateral and proximal nail folds may remain for 1 week, and can be improved by applying clobetasol cream. Infection, although rare, is the most common complication. An antibiotic is indicated in the case of postoperative infection.11 Unnecessary burn of proximal and lateral nail folds appears when the cotton swab is excessively moistened; the applicator must be moistened with phenol solution, but not dripping.9 Postoperative periostitis may occur when the nail matrix is strongly curetted. This procedure, when necessary, must be performed gently.12 Excessive detachment of the nail plate plus a dripping applicator may result in a temporary or definitive nail dystrophy. Care must be given to detach just the necessary lateral part of the nail plate.9
Postprocedural Care The limb should be elevated for 1 day. The dressing should be removed after 24 hours and the wound cleaned with 3% hydrogen peroxide. The patient should be advised to wash the wound twice a day and avoid closed shoes until the oozing disappears. The wound should be covered with a simple bandage. Patients should return for follow-up the next day and in 10, 30, and 60 days. The clinical results and a review of the literature are summarized in Table 1.13–16
Outcomes The results of nail phenolization are considered excellent, both functionally and cosmetically (Fig. 2).
DEBULKING OF THE PERIUNGUEAL SOFT TISSUE When an ingrowing nail is caused by hypertrophy of the nail folds, 2 different surgeries can be performed. The Howard-Dubois procedure is the best technique for mild to moderate cases,1 whereas the super U procedure is best for severe cases.17
Howard-Dubois Procedure After cleaning the digit involved with alcohol 70%, a tourniquet is applied and distal block anesthesia
Fig. 1. Technique of nail matrix phenolization. (A) Lateral ingrown toenail. (B) Granulation tissue is curetted. (C) Nail plate is detached from the proximal nail fold. (D) Nail plate is detached from nail bed. (E) Nail plate is cut from the free edge to the mail matrix. (F) Nail plate is removed using rotation motion. (G) The wound is cleaned. (H) Phenol solution (88%) is applied on the nail matrix with a cotton swab.
Best Way to Treat an Ingrown Toenail
Table 1 Recurrence rates of nail matrix phenolization Author, Year Kimata et al,13 1995 Bostanci et al,14 2001 Andreassi et al,15 2004 Di Chiacchio et al,16 2010
Number of Follow-up Recurrence Surgeries (mo) Rate (%) 537
6
1.1
350
25
0.6
948
18
4.3
267
33
1.9
Data from Refs.13–16
with lidocaine 2% without epinephrine is administered. A fish-mouth incision is made parallel to the distal groove around the tip of the toe, 5 mm below the distal and lateral grooves, running from the medial to the lateral aspect of the distal interphalangeal joint. A second incision is performed to create a wedge of approximately 7 mm at its greatest width in the middle of the distal wall. The crescent is removed using a sharp-pointed scissors. The wound edges must be approximated to determine whether enough tissue has been removed. If not, a new strip should be re-excised from the lower edge of the wound. Fat and fibrous tissue must be removed from the wound to ease the closure. The suture may be performed with simple interrupted stitches (nylon 4-0 or 5-0) or running lock stitches to avoid bleeding (Fig. 3).17
Management of complications Complications are unusual. Necrosis is possible in cases of overtightened sutures. Postprocedural care A very greasy nonadherent dressing covered with dry cotton is used to avoid bleeding. The dressing is replaced after 24 hours. The limb should be elevated for 48 hours. Pain is minimal to moderate, and analgesics should be prescribed. Stitches are removed after 14 days. Outcomes The nail plate grows normally and the cosmetic results are excellent with the Howard-Dubois technique (Fig. 4).
Super U Procedure This technique described by Rosa18 is very well indicated in cases of severe hypertrophy of nail folds. Patients should be advised that daily activities will be compromised during the postoperative period because of the long healing time (up to 2 months). After proximal or distal block anesthesia is administered, a tourniquet is applied and a U-shaped incision is performed from the proximal part of lateral nail fold, running through to the distal nail fold, and ending on the other side of lateral nail fold, comprising the whole hypertrophic tissue. A second incision begins on the lateral nail groove, in the same place as the first one, extending to the digit where the first incision ended. The hypertrophic tissue is held with a sturdy Adson forceps, and pulled to allow the tissue to be removed at bone contact with a sharp-pointed scissors. A running lock stitch, with nonabsorbable 3-0 or 4-0 suture, is performed around the first incision to avoid bleeding (Fig. 5).
Fig. 2. (A) Ingrown toenail of the lateral side. (B) Outcome after 3 months.
3
4
Di Chiacchio & Di Chiacchio
Fig. 3. Howard-Dubois technique. (A) A moderate case of ingrown toenail (lateral and distal). (B) Removal of skin and fat from one side to the other of the distal interphalangeal joint. (C) Suture with nylon 4-0. (D) Outcome after 2 months.
Fig. 4. Howard-Dubois technique. (A) Before surgery. (B) Outcome after 2 months.
Fig. 5. Super U technique. (A) Severe ingrown toenail (lateral and distal) with lateral granulation tissue. (B) Transverse incision from the proximal nail fold, running parallel with lateral and distal edge of the nail, from one side to the other. (C) Hypertrophic tissue is removed. (D) Running lock suture with nonabsorbable 4-0 suture.
Best Way to Treat an Ingrown Toenail
Fig. 6. (A) Severe ingrown toenail with hypertrophy of lateral and distal nail folds. (B) Outcome 6 months after super U technique.
Postprocedural care Alginate dressing is useful to cover the wound. A secondary dressing with dry cotton, covered with layers of mesh gauze, is applied on the alginate. All of the dressing is covered with a narrow elastic bandage, allowing precise pressure over the wound. The limb must be elevated for 2 days and painkillers are prescribed. The dressing is removed after 2 days by the surgeon. The wound is washed with 3% hydrogen peroxide solution to remove the remaining blood, and saline solution 0.9% and a simple dressing with a greasy antiseptic ointment is applied and renewed twice daily until healing is complete. Closed shoes should be avoided during the healing time. Management of potential complications Severe pain during the first 48 hours is common. Mild opioid-type narcotic analgesics (eg, dextropropoxyphene, tramadol, naloxone associated with tilidine) should be prescribed. Infection is rare if the wound is cleaned twice daily. In cases of infection, antibiotics should be prescribed. Outcomes Despite the long healing time, the improvement is dramatic with the super U technique (Fig. 6).
SUMMARY Nail phenolization is considered a useful procedure for treating ingrowing toenails. It is indicated when partial and definitive removal of the nail plate is necessary. It is simple and inexpensive, and associated with little postoperative discomfort, a quick return to normal activities, and a low rate of complication and recurrence. The results are cosmetically acceptable. The Howard-Dubois and super U techniques are indicated when ingrowing nails are caused by hypertrophy of nail folds, according to the degree of severity. Both techniques produce very good results, although the healing time and time until return to normal activities are longer with the super U technique.
REFERENCES 1. Richert B. Surgical management of ingrown toenails an update overdue. Dermatol Ther 2012;25(6): 498–509. 2. Arai H, Arai T, Nakajima H, et al. Simple and effective treatment for ingrowing nail. Rinsho Derma (Tokyo) 2002;44:1321–8. 3. Arai H, Arai T, Haneke E. Simple and effective conservative treatment for ingrowing nails (Acrylic affixed gutter splint, sculptured nail and anchor
5
6
Di Chiacchio & Di Chiacchio
4.
5.
6.
7.
8.
9.
10.
11.
taping methods). Rinsho Derma (Tokyo) 2010; 52(11):1604–13. Arai H, Arai T, Haneke E. Simple and effective non-invasive treatment methods for ingrown and pincer nail including acrylic affixed gutter splint, anchor taping, sculptures nails, shape memory alloy nail clip and plastic nail braces as well as 40% urea past. J Kochi Med Ass 2011; 16:37–56. Arai H, Arai T, Haneke E. Treatment of ingrown and pincer nail using acrylic affixed gutter splint, anchor taping and a shape memory alloy nail clip (CuAlMn). MB Derma 2011;184:108–19. Di Chiacchio N, Kadunc BV, Trindade de Almeida AR, et al. Treatment of transverse overcurvature of the nail with a plastic device: measurement of response. J Am Acad Dermatol 2006;55(6):1081–4. Eekhof JA, Van Wijk B, Knuistingh Neven A, et al. Interventions for ingrowing toenails. Cochrane Database Syst Rev 2012;(4):CD001541. Felton PM, Weaver TD. Phenol and alcohol chemical matrixectomy in diabetic versus nondiabetic patients. A retrospective study. J Am Podiatr Med Assoc 1999;89(8):410–2. Di Chiacchio N, Richert B, Haneke E. Surgery of the matrix. In: Richert B, Di Chiacchio N, Haneke E, editors. Nail surgery. 1st edition. London: Healthcare; 2010. p. 106. Aksakal AB, Atahan C, Oztas‚ P, et al. Minimizing postoperative drainage with 20% ferric chloride after chemical matricectomy with phenol. Dermatol Surg 2001;27(2):158–60. Dovison R, Keenan AM. Wound healing and infection in nail matrix phenolization wounds. Does
12.
13.
14.
15.
16.
17.
18.
topical medication make a difference? J Am Podiatr Med Assoc 2001;91(5):230–3. Tassara G, Machado MA, Gouthier MA. Treatment of ingrown nail: comparison of recurrence rates between the nail matrix phenolization classical technique and phenolization associated with nail matrix curettage - is the association necessary? An Bras Dermatol 2011;86(5):1046–8. Kimata Y, Uetake M, Tsukada S, et al. Follow-up study of patients treated for ingrown nails with the nail matrix phenolization method. Plast Reconstr Surg 1995;95(4):719–24. Bostanci S, Ekmekc¸i P, Gu¨rgey E. Chemical matricectomy with phenol for the treatment of ingrowing toenail: a review of the literature and follow-up of 172 treated patients. Acta Derm Venereol 2001; 81(3):181–3. Andreassi A, Grimaldi L, D’Aniello C, et al. Segmental phenolization for the treatment of ingrowing toenails: a review of 6 years experience. J Dermatolog Treat 2004;15(3):179–81. Di Chiacchio N, Belda W Jr, Di Chiacchio NG, et al. Nail matrix phenolization for treatment of ingrowing nail: technique report and recurrence rate of 267 surgeries. Dermatol Surg 2010;36(4):534–7. Richert B. Surgery of the lateral nail folds. In: Richert B, Di Chiacchio N, Haneke E, editors. Nail surgery. 1st edition. London: Healthcare; 2010. p. 89. Rosa IP. Hipercurvatura transversa da lamina ungueal e lamina ungueal que na˜o cresce. Remoc¸a˜o do “U” largo de pele, osteocorrec¸a˜o do leito e cicatrizac¸a˜o por segunda intenc¸a˜o (Tese). Sa˜o Paulo (Brazil): Universidade Federal de Sa˜o Paulo, Escola Paulista de Medicina; 2005. p. 156.
KEY POINTS Nail phenolization is considered a useful procedure for treating ingrowing toenails. Nail phenolization is indicated when partial and definitive removal of the nail plate is necessary. Nail phenolization is simple and inexpensive, and associated with little postoperative discomfort, a quick return to normal activities, and a low rate of complication and recurrence. The Howard-Dubois and super U techniques are indicated when ingrowing nails are caused by hypertrophy of nail folds, according to the degree of severity. The Howard-Dubois and super U techniques produce very good results, although the healing time and time until return to normal activities are longer with the super U technique.
NARROWING OF THE NAIL PLATE Nail phenolization is the best technique for definitive narrowing of the nail plate.7 It is well indicated in patients with diabetes and those using anticoagulants.8 Patients should be advised about the postoperative oozing and inflammatory process of proximal and lateral nail folds, and normal daily activities. Nail phenolization is considered easy to perform, but specialized training is required. After cleaning the involved digit with alcohol 70%, a tourniquet is applied and distal block anesthesia with lidocaine 2% without epinephrine is administered. When granulation tissue is present, it should be curetted to enable a better view of the nail plate to avoid excessive nail plate removal. The lateral involved nail plate is detached from the nail bed and the lateral and proximal nail folds (z3– 5 mm). The nail plate is split using a scissors or nail nippers from the free edge to the matrix and removed using a hemostat in a rotation motion.
a Dermatologic Clinic, Hospital do Servidor Pu´blico Municipal de Sa˜o Paulo, Sa˜o Paulo, Brazil; b Department of Dermatology, Medical School of ABC, Sa˜o Paulo, Brazil * Corresponding author. Rua Machado Pedrosa, 370, Sao Paulo 02045010, Brazil. E-mail address: [email protected]
Dermatol Clin - (2015) -–http://dx.doi.org/10.1016/j.det.2014.12.009 0733-8635/15/$ – see front matter Ó 2015 Elsevier Inc. All rights reserved.
derm.theclinics.com
An ingrown toenail is a common problem that causes significant morbidity and disability in daily life. An imbalance between the widths of the nail plate and the nail bed and the hypertrophy of nail folds are considered to be the causes.1 A large number of articles on the conservative treatment of ingrowing toenails have been described.2–6 Techniques such as massaging the nail folds, taping, gutter splinting, and orthesis may help in the treatment of ingrowing nails, especially in mild cases and in children. These treatments are lengthy and, when they are not well indicated, recurrence rates are considered high.7 Surgical treatment is indicated either when conservative treatments have failed or in moderate and severe cases.1 For cases in which nail is responsible for the ingrown toenail, the definitive narrowing of the nail plate is preferred. When the condition is caused by hypertrophy of nail folds, debulking of the periungueal soft tissues is performed.1 This article describes the best surgical treatment of ingrowing toenails.
2
Di Chiacchio & Di Chiacchio When necessary, the nail matrix, nail bed, and lateral nail fold are gently curetted to remove debris. A cotton swab is moistened with phenol solution 88% and applied to the lateral sulcus under the proximal fold and rubbed vigorously onto the matrix for 1 minute (Fig. 1).9
Management of Complications Oozing appears on the third day and may continue for up to 3 weeks. This oozing is improved by frequent washing of the wound, at least twice a day.9 A 20% ferric chloride solution can be used just after phenolization to improve postoperative drainage.10 Slight edema in the lateral and proximal nail folds may remain for 1 week, and can be improved by applying clobetasol cream. Infection, although rare, is the most common complication. An antibiotic is indicated in the case of postoperative infection.11 Unnecessary burn of proximal and lateral nail folds appears when the cotton swab is excessively moistened; the applicator must be moistened with phenol solution, but not dripping.9 Postoperative periostitis may occur when the nail matrix is strongly curetted. This procedure, when necessary, must be performed gently.12 Excessive detachment of the nail plate plus a dripping applicator may result in a temporary or definitive nail dystrophy. Care must be given to detach just the necessary lateral part of the nail plate.9
Postprocedural Care The limb should be elevated for 1 day. The dressing should be removed after 24 hours and the wound cleaned with 3% hydrogen peroxide. The patient should be advised to wash the wound twice a day and avoid closed shoes until the oozing disappears. The wound should be covered with a simple bandage. Patients should return for follow-up the next day and in 10, 30, and 60 days. The clinical results and a review of the literature are summarized in Table 1.13–16
Outcomes The results of nail phenolization are considered excellent, both functionally and cosmetically (Fig. 2).
DEBULKING OF THE PERIUNGUEAL SOFT TISSUE When an ingrowing nail is caused by hypertrophy of the nail folds, 2 different surgeries can be performed. The Howard-Dubois procedure is the best technique for mild to moderate cases,1 whereas the super U procedure is best for severe cases.17
Howard-Dubois Procedure After cleaning the digit involved with alcohol 70%, a tourniquet is applied and distal block anesthesia
Fig. 1. Technique of nail matrix phenolization. (A) Lateral ingrown toenail. (B) Granulation tissue is curetted. (C) Nail plate is detached from the proximal nail fold. (D) Nail plate is detached from nail bed. (E) Nail plate is cut from the free edge to the mail matrix. (F) Nail plate is removed using rotation motion. (G) The wound is cleaned. (H) Phenol solution (88%) is applied on the nail matrix with a cotton swab.
Best Way to Treat an Ingrown Toenail
Table 1 Recurrence rates of nail matrix phenolization Author, Year Kimata et al,13 1995 Bostanci et al,14 2001 Andreassi et al,15 2004 Di Chiacchio et al,16 2010
Number of Follow-up Recurrence Surgeries (mo) Rate (%) 537
6
1.1
350
25
0.6
948
18
4.3
267
33
1.9
Data from Refs.13–16
with lidocaine 2% without epinephrine is administered. A fish-mouth incision is made parallel to the distal groove around the tip of the toe, 5 mm below the distal and lateral grooves, running from the medial to the lateral aspect of the distal interphalangeal joint. A second incision is performed to create a wedge of approximately 7 mm at its greatest width in the middle of the distal wall. The crescent is removed using a sharp-pointed scissors. The wound edges must be approximated to determine whether enough tissue has been removed. If not, a new strip should be re-excised from the lower edge of the wound. Fat and fibrous tissue must be removed from the wound to ease the closure. The suture may be performed with simple interrupted stitches (nylon 4-0 or 5-0) or running lock stitches to avoid bleeding (Fig. 3).17
Management of complications Complications are unusual. Necrosis is possible in cases of overtightened sutures. Postprocedural care A very greasy nonadherent dressing covered with dry cotton is used to avoid bleeding. The dressing is replaced after 24 hours. The limb should be elevated for 48 hours. Pain is minimal to moderate, and analgesics should be prescribed. Stitches are removed after 14 days. Outcomes The nail plate grows normally and the cosmetic results are excellent with the Howard-Dubois technique (Fig. 4).
Super U Procedure This technique described by Rosa18 is very well indicated in cases of severe hypertrophy of nail folds. Patients should be advised that daily activities will be compromised during the postoperative period because of the long healing time (up to 2 months). After proximal or distal block anesthesia is administered, a tourniquet is applied and a U-shaped incision is performed from the proximal part of lateral nail fold, running through to the distal nail fold, and ending on the other side of lateral nail fold, comprising the whole hypertrophic tissue. A second incision begins on the lateral nail groove, in the same place as the first one, extending to the digit where the first incision ended. The hypertrophic tissue is held with a sturdy Adson forceps, and pulled to allow the tissue to be removed at bone contact with a sharp-pointed scissors. A running lock stitch, with nonabsorbable 3-0 or 4-0 suture, is performed around the first incision to avoid bleeding (Fig. 5).
Fig. 2. (A) Ingrown toenail of the lateral side. (B) Outcome after 3 months.
3
4
Di Chiacchio & Di Chiacchio
Fig. 3. Howard-Dubois technique. (A) A moderate case of ingrown toenail (lateral and distal). (B) Removal of skin and fat from one side to the other of the distal interphalangeal joint. (C) Suture with nylon 4-0. (D) Outcome after 2 months.
Fig. 4. Howard-Dubois technique. (A) Before surgery. (B) Outcome after 2 months.
Fig. 5. Super U technique. (A) Severe ingrown toenail (lateral and distal) with lateral granulation tissue. (B) Transverse incision from the proximal nail fold, running parallel with lateral and distal edge of the nail, from one side to the other. (C) Hypertrophic tissue is removed. (D) Running lock suture with nonabsorbable 4-0 suture.
Best Way to Treat an Ingrown Toenail
Fig. 6. (A) Severe ingrown toenail with hypertrophy of lateral and distal nail folds. (B) Outcome 6 months after super U technique.
Postprocedural care Alginate dressing is useful to cover the wound. A secondary dressing with dry cotton, covered with layers of mesh gauze, is applied on the alginate. All of the dressing is covered with a narrow elastic bandage, allowing precise pressure over the wound. The limb must be elevated for 2 days and painkillers are prescribed. The dressing is removed after 2 days by the surgeon. The wound is washed with 3% hydrogen peroxide solution to remove the remaining blood, and saline solution 0.9% and a simple dressing with a greasy antiseptic ointment is applied and renewed twice daily until healing is complete. Closed shoes should be avoided during the healing time. Management of potential complications Severe pain during the first 48 hours is common. Mild opioid-type narcotic analgesics (eg, dextropropoxyphene, tramadol, naloxone associated with tilidine) should be prescribed. Infection is rare if the wound is cleaned twice daily. In cases of infection, antibiotics should be prescribed. Outcomes Despite the long healing time, the improvement is dramatic with the super U technique (Fig. 6).
SUMMARY Nail phenolization is considered a useful procedure for treating ingrowing toenails. It is indicated when partial and definitive removal of the nail plate is necessary. It is simple and inexpensive, and associated with little postoperative discomfort, a quick return to normal activities, and a low rate of complication and recurrence. The results are cosmetically acceptable. The Howard-Dubois and super U techniques are indicated when ingrowing nails are caused by hypertrophy of nail folds, according to the degree of severity. Both techniques produce very good results, although the healing time and time until return to normal activities are longer with the super U technique.
REFERENCES 1. Richert B. Surgical management of ingrown toenails an update overdue. Dermatol Ther 2012;25(6): 498–509. 2. Arai H, Arai T, Nakajima H, et al. Simple and effective treatment for ingrowing nail. Rinsho Derma (Tokyo) 2002;44:1321–8. 3. Arai H, Arai T, Haneke E. Simple and effective conservative treatment for ingrowing nails (Acrylic affixed gutter splint, sculptured nail and anchor
5
6
Di Chiacchio & Di Chiacchio
4.
5.
6.
7.
8.
9.
10.
11.
taping methods). Rinsho Derma (Tokyo) 2010; 52(11):1604–13. Arai H, Arai T, Haneke E. Simple and effective non-invasive treatment methods for ingrown and pincer nail including acrylic affixed gutter splint, anchor taping, sculptures nails, shape memory alloy nail clip and plastic nail braces as well as 40% urea past. J Kochi Med Ass 2011; 16:37–56. Arai H, Arai T, Haneke E. Treatment of ingrown and pincer nail using acrylic affixed gutter splint, anchor taping and a shape memory alloy nail clip (CuAlMn). MB Derma 2011;184:108–19. Di Chiacchio N, Kadunc BV, Trindade de Almeida AR, et al. Treatment of transverse overcurvature of the nail with a plastic device: measurement of response. J Am Acad Dermatol 2006;55(6):1081–4. Eekhof JA, Van Wijk B, Knuistingh Neven A, et al. Interventions for ingrowing toenails. Cochrane Database Syst Rev 2012;(4):CD001541. Felton PM, Weaver TD. Phenol and alcohol chemical matrixectomy in diabetic versus nondiabetic patients. A retrospective study. J Am Podiatr Med Assoc 1999;89(8):410–2. Di Chiacchio N, Richert B, Haneke E. Surgery of the matrix. In: Richert B, Di Chiacchio N, Haneke E, editors. Nail surgery. 1st edition. London: Healthcare; 2010. p. 106. Aksakal AB, Atahan C, Oztas‚ P, et al. Minimizing postoperative drainage with 20% ferric chloride after chemical matricectomy with phenol. Dermatol Surg 2001;27(2):158–60. Dovison R, Keenan AM. Wound healing and infection in nail matrix phenolization wounds. Does
12.
13.
14.
15.
16.
17.
18.
topical medication make a difference? J Am Podiatr Med Assoc 2001;91(5):230–3. Tassara G, Machado MA, Gouthier MA. Treatment of ingrown nail: comparison of recurrence rates between the nail matrix phenolization classical technique and phenolization associated with nail matrix curettage - is the association necessary? An Bras Dermatol 2011;86(5):1046–8. Kimata Y, Uetake M, Tsukada S, et al. Follow-up study of patients treated for ingrown nails with the nail matrix phenolization method. Plast Reconstr Surg 1995;95(4):719–24. Bostanci S, Ekmekc¸i P, Gu¨rgey E. Chemical matricectomy with phenol for the treatment of ingrowing toenail: a review of the literature and follow-up of 172 treated patients. Acta Derm Venereol 2001; 81(3):181–3. Andreassi A, Grimaldi L, D’Aniello C, et al. Segmental phenolization for the treatment of ingrowing toenails: a review of 6 years experience. J Dermatolog Treat 2004;15(3):179–81. Di Chiacchio N, Belda W Jr, Di Chiacchio NG, et al. Nail matrix phenolization for treatment of ingrowing nail: technique report and recurrence rate of 267 surgeries. Dermatol Surg 2010;36(4):534–7. Richert B. Surgery of the lateral nail folds. In: Richert B, Di Chiacchio N, Haneke E, editors. Nail surgery. 1st edition. London: Healthcare; 2010. p. 89. Rosa IP. Hipercurvatura transversa da lamina ungueal e lamina ungueal que na˜o cresce. Remoc¸a˜o do “U” largo de pele, osteocorrec¸a˜o do leito e cicatrizac¸a˜o por segunda intenc¸a˜o (Tese). Sa˜o Paulo (Brazil): Universidade Federal de Sa˜o Paulo, Escola Paulista de Medicina; 2005. p. 156.
