Chemical Matrixectomy Research Articles

Management of skin necrosis after chemical matrixectomy with sodium hydroxide in ingrown toenail

Management of skin necrosis after chemical matrixectomy with sodium hydroxide in ingrown toenail

A survey of the treatment and management of ingrown toenails by UK podiatrists: A cross-sectional survey.

Ingrown toenails are a common pathology. Although a range of conservative and surgical measures are widely used for this condition, little is known about their use in practice. This study explored current practice relating to the treatment or management of ingrown toenails by podiatrists in the UK. A cross-sectional online survey (Qualtrics, Provo, UT, USA) conducted between March to June 2020 was distributed to practicing podiatrists treating or managing ingrown toenails in the UK. A total of 396 practicing podiatrists responded (60.1% based in the private sector). The majority (88.6%) performed nail surgery most commonly (54.3%) less than five a month. Nearly all (95%) only performed nail avulsion with or without chemical matrixectomy, universally using phenol (97.2%). Application time and number of applications varied but was most commonly applied three times (61.5%) for a total of 3minutes (75%). Aftercare varied considerably between public and private sectors, with public sectors offering fewer follow-up appointments. Although there is a variation in clinical practice throughout the treatment pathway, almost all respondents offered nail avulsion with phenol matrixectomy, whereas very few provided incisional nail surgery. This data provides the most comprehensive description of how UK podiatrists conduct nail surgery for onychocryptosis.

Postprocedural Opioid-Prescribing Practice in Nail Surgery.

Ingrown toenails are a common condition requiring outpatient procedures in podiatric medical clinics. To prevent recurrence, chemical matrixectomy is often recommended. Postprocedural pain management is largely based on preferences rather than on a formal guideline. This study aims to explore the postprocedural prescribing behavior among practicing podiatric physicians to foster future guideline and policy development. We administered an open, voluntary, anonymous questionnaire via an online survey platform that included a common nail procedure scenario (chemical matrixectomy) and a prescribed demographics section. Podiatric physicians were asked what they would prescribe to manage postprocedural pain. Opioid and nonopioid options were provided. We developed two multiple logistic regression models to identify associations between prescriber characteristics and prescribing opioids after "standard" chemical matrixectomy. Of the 860 podiatrists who completed the survey, 8.7% opted to prescribe an opioid. Hydrocodone was most commonly chosen. A median of 18 opioid pills were prescribed. No prescriber characteristics were associated with prescribing opioids after chemical matrixectomy scenario. There is a large discrepancy and knowledge gap in the literature on the optimal postprocedural pain management for outpatient procedures, including procedures in specialties such as dentistry and dermatology. The median number of opioids prescribed by podiatrists is higher than that by dentists for management of third molar extraction. In contrast, opioid-prescribing behavior among the 8.7% of respondents is similar to dermatologic management of postprocedural pain in Mohs surgery. Podiatric physicians cannot assume that their prescribing of opioids does not affect the opioid abuse problem in the United States. The presented study serves to be an initiation for procedure-specific opioid prescription benchmarking to foster future guideline and policy development. After nail procedures, opioids should not be routinely prescribed.

The effectiveness of matrix ablation with silver nitrate in the treatment of ingrown toenails. A single-center case-control study.

Partial onychectomy with chemical matrixectomy is considered the gold standard treatment for stage II-III ingrown toenails (IT). However, there are scarce reports describing the use of silver nitrate in IT management in adolescents. Our aim is to analyze the effectiveness of matrix ablation with silver nitrate and compare it with partial onychectomy by electrocautery. A retrospective study of adolescent patients with stage II-III IT was performed. Those who underwent electrocautery matricectomy in a major outpatient surgical center (Group A) and those who were treated with silver nitrate at an outpatient clinic (Group B) were compared. Efficacy was determined by recurrence and postoperative infection rates. Two hundred and nine patients were included (86 group A; 123 group B), with a total of 382 partial onychectomies (151 group A; 231 group B). Group B patients exhibited a lower recurrence rate (4.7%) when compared to group A (11.2%, p= .02), and had a lower postoperative infection rate (4.0% group A vs. 1.7% group B; p= .18), although not statistically significant. Silver nitrate chemical matricectomy after partial onychectomy is an effective treatment for IT in adolescents, with few postoperative complications and low recurrence rate. Therefore, it should be considered as a possible alternative to electrocautery matricectomy.

Effectiveness of Leukocyte and Platelet-Rich Fibrin versus Nitrofurazone on Nail Post-Surgery Bleeding and Wound Cicatrization Period Reductions: A Randomized Single Blinded Clinical Trial.

Background: Leukocyte and platelet-rich fibrin (L-PRF) may be considered a co-adjuvant intervention that may play a key role in blood coagulation and tissue repair after nail surgeries. The aim of this study was to determine the effectiveness of L-PRF versus nitrofurazone on the post-surgical bleeding and wound cicatrization period in patients with bilateral onychocryptosis during surgeries of chemical matrixectomies with 88% phenol solution. Methods: A randomized single-blind clinical trial was registered with the European Clinical Trials Database (EudraCT) with identification number 2016-002048-18. Twenty healthy participants with bilateral onychocryptosis (n = 40) were recruited and bilaterally received both protocols for both halluces. Patients with a mean age mean of 45.55 ± 12.19 years attended a specialized foot and ankle surgery clinic. Both halluces of each patient were randomized and allocated to receive L-PRF (experimental group; n = 20 halluces) or nitrofurazone (control group; n = 20 halluces) interventions in conjunction with surgery of chemical matrixectomies with 88% phenol solution for bilateral ingrown of toenail border (medial and lateral). Patients were blinded to their intervention in each hallux. The primary outcome measurement was post-surgical bleeding. The secondary outcome measurements were post-surgical pain intensity, inflammation, infection, analgesic intake, and wound cicatrization period. Results: Statistically significant differences (p < 0.001) were found between both groups showing a reduction for wound cicatrization period and post-surgical bleeding for the L-PRF intervention with respect to nitrofurazone treatment. The rest of the outcome measurements did not show any statistically significant differences (p > 0.05). Conclusions: L-PRF rather than nitrofurazone in conjunction with chemical matrixectomies performed with 88% phenol solution reduced the wound cicatrization period and bleeding after nail surgery. Thus, L-PRF may be considered a first-line co-adjuvant intervention for patients who suffer from nail problems, such as onychocryptosis, that require surgical procedures.

Onychoplasty with 1064-nm Laser: Matrixectomy for Treatment of Ingrown Toenails.

Onychocryptosis is a common pathology treated by podiatry medical services, and in a considerable percentage, surgical procedures are required to achieve a solution. There are multiple surgical approaches for ingrown toenails, both incisional procedures and nonincisional procedures, such as chemical matrixectomies and physical matrixectomies using carbon dioxide laser. This study presents a surgical procedure for onychocryptosis using a physical matrixectomy with a 1064-nm laser applied by means of a 400-μm optical fiber and surgical removal of the posterior cauterized tissue to achieve healing by primary intention. This technique was performed on 30 patients with onychocryptosis affecting the great toe (Mozena stages I and IIa), and all of the patients were followed up postoperatively for 12 months. The patients reported minimal postoperative pain, quicker surgical postoperative healing, rapid return to activities of daily living, and minor postoperative recurrence compared with previous studies using incisional procedures and chemical matrixectomies.

Portable Diode Laser Scalpel in Treatment of Ingrown Toenails in Children

Introduction.The ingrown nail (onychocryptosis) is a disease that is common both among children and in adult population. Despite the fact that there is a large number of methods available for the treatment of ingrown nails, a large percentage of recurrence of the disease remains unconquered. Traditional methods of treatment today are often complemented by chemical matrixectomy, cryodestruction, electrocoagulation or laser destruction of the growth zone of the nail plate piece being removed. The purpose of all of these methods of treatment is the reduction of the recurrence of the disease. This study aims to examine the possibilities of using a portable diode laser scalpel for the treatment of ingrown nails in children.Materials and methods.In this study the authors compared treatment outcomes in patients with ingrown toenails treated with the original Winograd procedure (30 patients) with those treated with the same procedure complemented by the laser destruction of the growth zone (50 patients).Results and discussion.There was one relapse case in the study group (n=50, 2%), and two — in the control group (n=30, 6.7 %). The healing period of the postoperative wound amounted to 17.3±2.05 days in the study group and to 12.25±1.24 days in control. Pain VAS scores on the first day following the surgery were 6.2±1.24 in the study group, and 5.8±0.816 in control. Staphylococcus aureus was the pathogen responsible for the local infection process in most patients with ingrown nails.Conclusion. This study demonstrates that using the method proposed results in the reduction of the risk of recurrence of the disease from 6.7% down to 2%, increasing, however, the healing time of the postoperative wound from 12.25±1.24 to 17.3±2.05 days. This makes the use of the method proposed advisable in patients with: a stage III ingrown nail; an apparent local infectious process; a recurrent ingrown nail.

Eficacia de las técnicas quirúrgicas más utilizadas en el tratamiento de la onicocriptosis: una revisión sistemática

BackgroundThe onychocryptosis, commonly known as ingrown toenail, is a condition of the nail apparatus in which damages the nail fold. This causes pain and inflammation and has serious alterations person's quality of life, causing inability to perform daily activities. So, is very important to choose a good treatment. Material and methodsA literature review was conducted to assess which surgical technique for the treatment of onychocryptosis was the most frequently used in the period (2007-2014), and which has lower rate of relapse and / or recurrence presented. The selection resulted in 13 articles evaluating chemical matrixectomies techniques and wedge resection technique, Suppan I or similar. ResultsThe chemical matrixectomies was the most employed techniques to treat ingrown toenails, mainly employing phenol as caustic agent. In the same way, had significantly lower rates of relapse and / or recurrence (2.02%) than wedge resection techniques or Suppan technique ConclusionsChemical matrixectomies are currently the most widely used surgical techniques, which provide good results and low recurrence rates presented, so are considered the most effective technique for the treatment of onychocryptosis.

Enhanced Removal of Phenol with Saline Solution Over Alcohol: An In Vitro Study

Phenol cauterization is a chemical equivalent often chosen for treatment of ingrown toenails. Many reports describe intraoperative irrigation, or lavage, of the wound with various types of alcohol to neutralize any remaining phenol. There are conflicting reports in the literature as to whether true neutralization or merely effective removal of excess phenol is needed. The aim of our study was to analyze the suitability and effectiveness of ethyl alcohol versus sterile saline when used in a lavage step after phenol application in the treatment of ingrown toenails. We performed an in vitro study using human skin and a diffusion cell apparatus to measure the amount of phenol recovered after lavage with ethyl alcohol or sterile saline. When the wound was irrigated with ethyl alcohol, the total phenol recovered after two irrigation washes was 55.7% of the original amount initially used in treatment, compared with 80.4% when sterile saline solution was used for irrigation. Alcohol and sterile saline solution do not neutralize phenol but dilute it and aid in its removal. We found that saline solution recovered more phenol than when washing with alcohol and recommend its use instead of alcohol for irrigation purposes after chemical matrixectomy.

Renal excretion of phenol from physicians after nail matrix phenolization: an observational prospective study

Animal studies have shown that many signs of acute poisoning result from phenol entry into the systemic circulation by absorption or ingestion. While no evidence of systemic complications in patients who have undergone phenol nail matrixectomies have been reported, the safety of phenol vapour inhalation by physicians performing this treatment has yet to be investigated. The goal of this study was to determine whether the levels of phenol to which physicians are exposed to during a phenol-based matrixectomy procedure are within the limits of safe exposure. A continuous prospective study was carried out to measure the urinary phenol concentrations from physicians after performing chemical matrixectomy for ingrown toenails. The highest concentration of urinary phenol was measured at almost 10 mg/L within the first 2 h after exposure, and subsequently decreased approximately 1 mg/L every 2 h for the first 10 h post exposure. The levels dropped to 3 mg/L at 72 h post exposure. The risk associated with phenol exposure while performing chemical phenol matrixectomy was well below the current safety limits when the physician is exposed to 90% phenol vapour for approximately 20 min. Thus, no further specific safety recommendations are required for physicians performing this procedure.

Safety of Phenol Vapor Inhalation during Performance of Chemical Matrixectomy to Treat Ingrown Toenails

Safety of Phenol Vapor Inhalation during Performance of Chemical Matrixectomy to Treat Ingrown Toenails

Safety of Phenol Vapor Inhalation during Performance of Chemical Matrixectomy to Treat Ingrown Toenails

Phenol is commonly used in chemical matrixectomies to treat ingrown toenails. Although many studies have documented the safety of phenol matrixectomy for the patient, few studies have investigated the procedure's safety for the physician and auxiliary health care personnel. This study was undertaken to evaluate the safety of phenol vapor inhalation for health care personnel during performance of chemical matrixectomy. The environmental concentrations of phenol in the respiration zones of the physician and an assistant were measured during an in-office surgical procedure consisting of two partial chemical matrixectomies using a 95% phenol solution. The samples were analyzed using gas chromatography with a flame ionization detector. The phenol concentration measured in the physician's respiration zone was close to Spain's established environmental limit of daily exposure, with an index of exposure of 60%. The concentration measured in the assistant's respiration zone was well below the environmental limit of daily exposure, with an index of exposure of only 10%. The performance of chemical matrixectomies is safe for health care personnel when they are exposed to the vapor of phenol solutions of up to 95% concentration for up to 21 minutes. The degree of safety would be greater with lower phenol concentrations and shorter exposure times.

Treatment of ingrown toenails in the pediatric population

Background/PurposeNail avulsion plus chemical matrixectomy (CM) using NaOH as an alternative to surgical matrixectomy (SM) has recently been used in the treatment of ingrown toenails (IGTNs) in adults. No studies exist to dictate the most effective and safe treatment method in the pediatric population. MethodsA retrospective review of pediatric IGTNs treated at 2 institutions for 6 years was done, looking at presentation, treatment modality, SM vs CM, and outcomes. ResultsEight hundred forty-eight IGTNs in 518 patients were reviewed with an average age of 12.5 years. Twenty-three percent were felt to be infected at the time of presentation, and 34% were being treated with antibiotics within the preceding week of surgery. Seventy-nine percent of toenails underwent surgical management with the most common procedure being avulsion plus SM (65%), followed by avulsion plus CM (17%), and avulsion alone (14%). The overall recurrence rate after initial surgery was 19.5%. After adjusting for covariates, recurrence was associated with treatment by avulsion alone (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.5-4.7), avulsion plus CM (OR, 0.3; 95% CI, 0.1-0.7), and treatment with antibiotics within the week before surgery (OR, 0.5; 95% CI, 0.3-0.9; P = .017). The overall postoperative infection rate was 6% and was unrelated to presence of preoperative infection, use of antibiotics, or surgical treatment method. ConclusionsIngrown toenails present a significant problem to youth and should be addressed in a diligent fashion. Chemical matrixectomy using NaOH is a safe and effective alternative to SM and maybe associated with a lower rate of recurrence, especially when use in conjunction with preoperative antibiotics.

Onychoplasty with Carbon Dioxide Laser Matrixectomy for Treatment of Ingrown Toenails

Ingrown toenails are one of the most common pathologic conditions encountered in podiatric medical practice. Many methods of treatment for ingrown toenails have been used and studied, including chemical matrixectomies, surgical approaches, and CO(2) laser ablation. This study is a retrospective review of a new technique that consists of resection of the involved nail matrix using a No. 15 blade and controlled cauterization using a CO(2) laser. The technique was performed on 381 painful ingrown toenails, and all of the patients were followed up postoperatively for an average of 34 months. The results showed minimal pain, a low recurrence rate, rapid return to activity, and good cosmesis.

Reconstruction of the Great Toe Ski-Slope, Sunken-Nail Deformity with a Buried Adipofascial Flap

Development of a ski-slope deformity following loss of the great toe nail plate is a problematic condition with few conservative or surgical options available. The condition becomes more difficult to treat when the distal, medial, and lateral labial nail folds are hypertrophied, creating the appearance of a sunken nail. We present a case of ski-slope, sunken-nail deformity following multiple attempts at chemical nail matrixectomy. The patient's persistent pain and deformity were managed through 1) nail plate avulsion and complete surgical excision of the germinal nail matrix, 2) remodeling of the distal phalanx, and 3) elevation of an adipofascial flap from the plantar tuft of the great toe, which was brought from plantar to dorsal and interposed between the dorsal aspect of the distal phalanx and the overlying nail bed in buried fashion. The combination of these procedures elevated the nail bed, which restored normal architecture to the great toe and relieved the pain associated with the chronic deformity. This case demonstrates a potential complication of a commonly performed procedure and a salvage technique useful for dealing with the resultant ski-slope, sunken-nail deformity.

Scientific analysis of phenol nail surgery.

Chemical matrixectomy using phenol is one of the most common surgical procedures for the permanent removal of toenails. The concentration of phenol solution and duration of its application have varied widely and have not been subjected to scientific study. The authors studied the histologic effects of phenol on the nail matrix and determined the optimal concentration of phenol and time the phenol solution needs to be in contact with the nail bed.

Office management of ingrown toenails (chronic onychocryptosis): permanent matrixectomy using the chemical destruction technique

The phenol chemical matrixectomy technique for onychocryptosis is a very effective and minimally time-consuming procedure. The incidence of postoperative complications is limited, with the most frequent being slight return of spiculization of the nail border. When this occurs, one or two reapplications of 89% phenol for 45 seconds usually suffices. This technique is suitable for any age group other than infants, in whom the phenol could possibly damage the underlying bony surface. The procedure is totally ambulatory, and patients are able to return to normal shoe gear and activity within two to three days after it is performed.

Chemical matrixectomy for ingrown toenails: Is there an evidence basis to guide therapy?

Chemical matrixectomy for ingrown toenails is one of the most common surgical procedures performed on the foot. The procedure was first described in 1945 by Otto Boll, who discussed the use of phenol to correct ingrown toenails. In the years that followed, many variations of technique and method have been described. This article reviews the pertinent literature detailing chemical matrixectomies and advocates the use of an evidence basis for care.