Abstract
Background: In onychocryptosis surgery, incisional and non-incisional matricectomy is indicated according to the stage. The chemical matricectomy with 88% phenol solution is the gold standard and a wedge resection is indicated for more advanced stages. The aesthetic reconstruction has the advantages of the incisional procedure without eponychium incisions and an effectiveness similar to the chemical matricectomy with phenol. Objective: To compare the recurrence and the healing time between the chemical matricectomy with phenol and the aesthetic reconstruction. Methods: A comparative, prospective, parallel, randomized, and one-blinded clinical trial was registered with the European Clinical Trials Database (EudraCT) with identification number 2019-001294-80. Thrity-four patients (56 feet) with 112 onychocryptosis were randomized in two groups. Thirty-six were treated with chemical matricectomy with phenol and 76 with aesthetic reconstruction. Each patient was blind to the surgical procedure assigned by the investigator. The primary outcome measurements were healing time and recurrence. The secondary outcome measurements were post-surgical bleeding, pain, inflammation, and infection rate. Results: The aesthetic reconstruction procedure presents a shorter healing time (8.2 ± 1.4 days vs. 21.3 ± 3.1 days; p < 0.001) with a similar recurrence rate (p = 0.98). Post-operatory bleeding, pain, inflammation, and the infection rate did not show significant differences (p > 0.05). Conclusions: The aesthetic reconstruction presents a shorter healing time, favoring the patients’ recuperation, with a recurrence similar to the chemical matricectomy with 88% phenol solution.
Highlights
Onychocryptosis is a pathologic condition of the nail apparatus in which the toenail damages the nail fold
Local application of phenol solution may be considered as the first non-incisional surgical option with a recurrence rate of less than 5% [11]
Significant differences were set at p < 0.05 with a 95% confidence interval (CI). ** Qualitative variable; frequencies. *** Yates’ Chi-square test. This clinical trial means to compare one of the chemical procedures most noted in the literature and applied in clinical practice [12], chemical matricectomy with phenol, with the aesthetic reconstruction procedure [1], with the aim of clarifying its preference in nail surgery
Summary
Onychocryptosis is a pathologic condition of the nail apparatus in which the toenail damages the nail fold. There exist various non-incisional surgical options, such as the gold standard procedure, chemical matricectomy with 88% phenol solution, and its modifications [7,8,9], such as the modification which eliminates cauterized tissue via thorough curettage [1], or different duration for the application time of phenol [10]. Local application of phenol solution may be considered as the first non-incisional surgical option with a recurrence rate of less than 5% [11]. Results: The aesthetic reconstruction procedure presents a shorter healing time (8.2 ± 1.4 days vs 21.3 ± 3.1 days; p < 0.001) with a similar recurrence rate (p = 0.98). Conclusions: The aesthetic reconstruction presents a shorter healing time, favoring the patients’ recuperation, with a recurrence similar to the chemical matricectomy with 88% phenol solution
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