Journal Information
Vol. 96. Issue 5.
Pages 651-653 (01 September 2021)
Share
Share
Download PDF
More article options
Visits
...
Vol. 96. Issue 5.
Pages 651-653 (01 September 2021)
Correspondence
Open Access
Considerations on the development of surgical techniques for the treatment of onychocryptosis
Visits
...
Anna Carolina Miola
Corresponding author
anna.c.miola@unesp.br

Corresponding author.
, Giovana Piteri Alcantara, Luciane Donida Bartoli Miot, Helio Amante Miot
Department of Dermatology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil
Article information
Full Text
Bibliography
Download PDF
Statistics
Tables (1)
Table 1. Characteristics of the main surgical techniques described for onychocryptosis.
Full Text
Dear Editor,

As onychocryptosis is a frequent demand in dermatological assistance, and its surgical management requires both specific training and indication criteria, we read with interest the article by Ma,1 which aimed to describe a new surgical approach for onychocryptosis.

Currently, there is no consensus, nor a body of evidence on the specific differences of the several surgical techniques for onychocryptosis, or on their comparison in terms of effectiveness, morbidity, infection, cost-effectiveness and technical difficulty. Therefore, the development of new methods is of scientific relevance and should be critically appreciated considering the described surgeries, especially regarding the technical differences and recurrence rates after 12 months.

Despite the interesting results presented by Dr. Ma, the proposed surgical technique sequence is very similar to the classic matricectomy described by Winograd (1929),2 which has undergone several adaptations over the years.3,4 Moreover, although low, there is an expected recurrence rate of approximately 6% in virtually all studies that used the Winograd method or its variants.4 As this is a similar surgical approach, the result shown by Ma, who found no recurrence in 67 surgeries (with a follow-up of 6 to 12 months), may not represent a difference in relation to the expected rate of 6% (p = 0.119 – Fisher Exact test) due to modest sample size. However, it can also be due to the small percentage of cases with grade I onychocryptosis, which usually do not show recurrence and whose frequency was not discriminated by the author.

Table 1 depicts the main technical characteristics of the Winograd method and its main variants, its recurrence rates, in addition to chemical matricectomy with 88% phenol and 80% trichloroacetic acid, for comparison.5

Table 1.

Characteristics of the main surgical techniques described for onychocryptosis.

Publication  Technique  Recurrence rate 
Winograd AM. J Am Podiatr Med Assoc 2007; 97:274-7.Incision of the eponychium  10Zero in 6 months
Removal of the nail plate to the matrix 
Matrix curettage, dressing 
Uygur E, et al. Int J Surg 2016; 34:1-5.Winograd method  12814% in 6 months
Posterior suture of the surgical wound on the nail plate 
Acar E. J Foot Ankle Surg 2017; 56:474-7Winograd method  102Zero in 12 months
Electrocoagulation of the matrix 
Karaca N. et al. Ann Fam Med 2012; 10: 556-9  Partial excision of the proximolateral matrix and phenolization of the matrix  348  0.3% in 24 months 
Aksoy, et al. Dermatol Surg 2009; 35:462-8.  Transposition flap of proximal nail fold with partial matricectomy  52  3.9% in 12 months 
Osan F, et al. Dermatol Surg 2014; 40:1132-9.  Partial matricectomy with curettage (group 1) vs. Partial matricectomy with electrocauterization (group 2)  92 (group 1) vs57 (group 2)  2% in 10 meses (group 1) vs. Zero in 10 months (group 2) 
Dąbrowski M, et al. Ann Med Surg 2020; 56:152-160.Wedge-shaped excision of tissue lateral to the nail plate  541.8% in 11 months
Preservation of the nail matrix 
Kimata, et al. Plast Reconstr Surg 1995; 95:719-24.Partial avulsion of the lateral nail plate  5371% in 6 months
Chemical matricectomy with 88% phenol 
Barreiros H, et al. An Bras Dermatol 2013; 88:889-93.Partial avulsion of the nail plate and lateral nail matrix  1971.5% in 12 months
Chemical matricectomy with 80% trichloroacetic acid 
Muriel-Sanchez JM, et al. J Clin Med 2020; 9:845.  Avulsion of the lateral nail plate to the eponychium and curettage of the nail matrix and nail bed (group 1) vs. Nail plate avulsion to the eponychium and 88% phenolization of the nail matrix (group 2)  76 (group 1) vs. 36 (group 2)  1.52% in 6 meses (group 1) vs. 2.8% in 6 months (group 2) 
Montesi S, et al. Dermatology 2019; 235:323-6.  88% phenolization of the nail matrix for 4 minutes  622  1.1% in 12 months 
Terzi E, et al. Dermatol Surg 2017; 43: 728-33.  Avulsion of the lateral nail plate to the eponychium and chemical matricectomy with 90% dichloroacetic acid  58  3.3% in 12 months 

Surgical techniques for the treatment of onychocryptosis require careful systematization of the operative sequences and approach to the matrix, as well as the precise indication according to tissue hyperplasia, nail plate situation and pyogenic granuloma. Only the comparative analysis of the performance of the techniques, stratified according to the indications, can lead to criticism, aiming to maximize the performance of the procedures.

Due to the peculiar anatomy of the nail apparatus, surgical approaches to onychosis require specialized training by the dermatologist. However, despite the high prevalence of onychocryptosis and impact on quality of life, there is a lack of well-conducted comparative clinical trials that favor the personalization of indications. Moreover, it is crucial to review the previously described surgical techniques, both for their historical and scientific value, when one proposes the standardization of a new surgical technique.

Financial support

None declared.

Authors’ contributions

Anna Carolina Miola: Approval of the final version of the manuscript; drafting and editing of the manuscript; critical review of the literature; critical review of the manuscript.

Giovana Piteri Alcantara: Drafting and editing of the manuscript; critical review of the manuscript.

Luciane Donida Bartoli Miot: Drafting and editing of the manuscript; critical review of the manuscript.

Hélio Amante Miot: Approval of the final version of the manuscript; drafting and editing of the manuscript; critical review of the literature; critical review of the manuscript.

Conflicts of interest

None declared.

References
[1]
H. Ma.
Six steps to standardize surgical approach for ingrown toenail.
An Bras Dermatol, 96 (2021), pp. 47-50
[2]
A.M. Winograd.
A modification in the technic of operation for ingrown toe-nail. 1929.
J Am Podiatr Med Assoc, 97 (2007), pp. 274-277
[3]
E. Uygur, E. Çarkçi, A. Şenel, B. Kemah, Y. Turhan.
A new and simple suturing technique applied after surgery to correct ingrown toenails may improve clinical outcomes: A randomized controlled trial.
Int J Surg, 34 (2016), pp. 1-5
[4]
E. Acar.
Winograd Method Versus Winograd Method With Electrocoagulation in the Treatment of Ingrown Toenails.
J Foot Ankle Surg, 56 (2017), pp. 474-477
[5]
Y. Kimata, M. Uetake, S. Tsukada, K. Harii.
Follow-up study of patients treated for ingrown nails with the nail matrix phenolization method.
Plast Reconstr Surg, 95 (1995), pp. 719-724

How to cite this article: Miola AC, Alcantara GP, Miot LDB, Miot HA. Considerations on the development of surgical techniques for the treatment of onychocryptosis. An Bras Dermatol. 2021;96:651–3.

Study conducted at the Department of Dermatology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil

Copyright © 2021. Sociedade Brasileira de Dermatologia
Idiomas
Anais Brasileiros de Dermatologia

Subscribe to our newsletter

Article options
Tools
en pt
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.