J Korean Foot Ankle Soc.  2019 Jun;23(2):52-57. 10.14193/jkfas.2019.23.2.52.

Short-Term Surgical Outcome of the Partial Nail Extraction in Ingrown Nail of Military Trainee: Is Matrixectomy Necessary?

• Kim J
• Kim YS
• Yi Y

• KMID: 2449672
• DOI: http://doi.org/10.14193/jkfas.2019.23.2.52

Abstract

PURPOSE
An ingrown nail is common in military trainees who are exposed to highly demanding activities. Although the matrixectomy procedure has been the main treatment modality, several drawbacks may follow after the procedure, such as infection, periostitis, and continued pain that causes a delayed return to duty. This study examined the outcomes of a simple partial nail extraction with the hypothesis that this procedure may bring an earlier return to duty, lower the perioperative complications, and produce a comparable recurrence rate.
MATERIALS AND METHODS
The medical records of patients who had surgical treatment for an ingrown nail in the authors' institution between April 2016 and December 2017 were reviewed retrospectively. Under the inclusion and exclusion criteria, 28 patients with a simple partial nail extraction (group A) and 29 patients with a partial nail extraction with matrixectomy (group B) were investigated. As the clinical outcome, the visual analogue scale (VAS) and satisfaction score, time to return to duty, complications, and recurrence rate were checked and compared between the groups.
RESULTS
The VAS scores of group B were significantly higher during the first (p<0.001) and second (p=0.026) follow-up week than group A. The time to return to duty was shorter in group A (7.8 days) than group B (10.1 days), and this difference was significant (p<0.001). Group B had five patients with complications, whereas group A had none (p=0.028). No differences in the recurrence rate (p=0.197) and patient satisfaction (p=0.764) were found between the groups.
CONCLUSION
In this study, simple partial nail extraction in military trainees resulted in lower postoperative pain, lower complication rates, and earlier return to duty than the procedure with matrixectomy. Military trainees are temporarily exposed to highly demanding activities. Thus, a satisfactory outcome would be expected with simple partial nail extraction without performing a radical procedure, such as a matrixectomy.

Keyword

Toes; Ingrown nail; Military personnel; Partial nail extraction; Matrixectomy

MeSH Terms

Follow-Up Studies
Humans
Medical Records
Military Personnel*
Nails, Ingrown*
Pain, Postoperative
Patient Satisfaction
Periostitis
Recurrence
Retrospective Studies
Toes

Figure

• 

  Figure 1. Simple partial nail extraction. (A) Elevate nail edge with freer elevator. (B) Cut adequate amount of nail with scissor deep to proximal nail plate. (C) Elevate the proximal end of nail together with lateral nail horn. (D) Note the lateral nail horn is completely pulled out from the nail fold. (E) After partial nail extraction. (F) Excised nail. Note lateral nail horn (asterisk) is completely excised.

• 

  Figure 2. Partial nail extraction. (A) Ingrown nail with inflammation. (B) The portion inside the red dotted line (partial nail with medial or lateral horn) is excised without an incision on proximal nail fold and eponychium. (C) Wound closure was not performed.

• 

  Figure 3. Partial nail extraction with ma-trixectomy. (A) Ingrown nail with inflammation. (B) The portion inside the red dotted line (partial nail with medial or lateral horn and matrix) is ablated with an incision on proximal nail fold and eponychium. (C) Wound closure was performed.

• 

  Figure 4. Mean visual analogue scale (VAS) score during follow-up period between two groups. *Statistically significant (p<0.05).

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