scholarly journals A novel surgical method for total nail ablation: Use of triple flap technique

2017 ◽  
Vol 3 (1) ◽  
Author(s):  
Berna Aksoy ◽  
Hasan Mete Aksoy
Keyword(s):  
Nail Plate ◽  
Dorsal Surface ◽  
Treatment Method ◽  
Advancement Flap ◽  
Nail Bed ◽  
Cosmetic Appearance ◽  
Flap Technique ◽  
Nail Matrix ◽  
Skin Coverage ◽  
Transverse Strip

<p>Total nail ablation for the treatment of onychodystrophies can be performed by using chemicals, surgical resection or laser ablation of nail matrix.<strong> </strong>A female patient with bilateral severe onychodystrophy as a result of inadvertent previous nail surgeries was treated surgically. Proximal complete nail matrix resection and distal 10 mm wide transverse strip partial nail bed resection were performed. A 5 mm wide transverse strip of nail bed was left intact proximally. Proximal nail matrix defect was closed by using the skin of proximal nail fold. The distal nail bed defect was reconstructed by using triple flap technique which was composed of a main central advancement flap containing ventral toe skin and two side flaps containing nail fold skin. The patient healed without any problem and her nail problem was treated successfully. The cosmetic appearance of her first toes was acceptable. Surgical nail ablation followed by volar skin coverage of dorsal surface of the distal phalanx bone by using triple flap technique is an effective surgical treatment method for the correction of advanced nail plate deformities requiring total nail ablation. </p>

Diseases of the Nail Unit

2012 ◽  
Author(s):  
Jennifer Nguyen ◽  
George Cotserelis
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Lichen Planus ◽  
Late Stage ◽  
Potassium Hydroxide ◽  
Nail Plate ◽  
Longitudinal Section ◽  
Antifungal Treatment ◽  
Nail Bed ◽  
Nail Psoriasis ◽  
Nail Matrix

The human nail is a complex unit that includes five major modified cutaneous structures: the nail matrix, nail bed, nail plate, nail folds, and cuticle (eponychium). This chapter discusses the function and structure of the five nail components and the pathophysiology affecting each. Also reviewed are nail findings associated with underlying systemic and dermatologic conditions: splinter hemorrhages, koilonychia, transverse nail-plate depressions (Beau’s lines), onycholysis, leukonychia, clubbing, nail-plate pitting, and longitudinal pigmented bands. Infections of the nail are discussed, which include bacterial paronychia, chronic paronychia, and onychomycosis. Figures illustrate the longitudinal section of the fingernail, multiple pigmented longitudinal bands, psoriasis involving the fingernail, late-stage lichen planus of the fingernail, transverse linear grooves, Pseudomonas aeruginosa causing a green nail, psoriasis of the nail, melanonychia striata, and a nail specimen for potassium hydroxide preparation. Tables describe antifungal treatment for toenail onychomycosis as well as selected dermatologic disorders that affect the nail unit. This chapter contains 50 references.

Diseases of the Nail Unit

2015 ◽  
Author(s):  
Jennifer Nguyen ◽  
George Cotserelis
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Lichen Planus ◽  
Late Stage ◽  
Potassium Hydroxide ◽  
Nail Plate ◽  
Longitudinal Section ◽  
Antifungal Treatment ◽  
Nail Bed ◽  
Nail Psoriasis ◽  
Nail Matrix

The human nail is a complex unit that includes five major modified cutaneous structures: the nail matrix, nail bed, nail plate, nail folds, and cuticle (eponychium). This chapter discusses the function and structure of the five nail components and the pathophysiology affecting each. Also reviewed are nail findings associated with underlying systemic and dermatologic conditions: splinter hemorrhages, koilonychia, transverse nail-plate depressions (Beau’s lines), onycholysis, leukonychia, clubbing, nail-plate pitting, and longitudinal pigmented bands. Infections of the nail are discussed, which include bacterial paronychia, chronic paronychia, and onychomycosis. Figures illustrate the longitudinal section of the fingernail, multiple pigmented longitudinal bands, psoriasis involving the fingernail, late-stage lichen planus of the fingernail, transverse linear grooves, Pseudomonas aeruginosa causing a green nail, psoriasis of the nail, melanonychia striata, and a nail specimen for potassium hydroxide preparation. Tables describe antifungal treatment for toenail onychomycosis as well as selected dermatologic disorders that affect the nail unit. This chapter contains 50 references.

scholarly journals Ultrasonographic and resistance index evaluation of nails in psoriatic arthritis, psoriasis, and control groups: a cross-sectional study

2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Samanta Daiana De Rossi ◽  
José Alexandre Mendonça ◽  
Penelope Ester Palominos ◽  
Charles Lubianca Kohem ◽  
Tania Ferreira Cestari ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Plate Thickness ◽  
Nail Plate ◽  
Resistance Index ◽  
Cross Sectional Study ◽  
Type I ◽  
Sectional Study ◽  
Cross Sectional ◽  
Nail Bed ◽  
Nail Matrix

Abstract Background Nail psoriasis occurs frequently in patients with psoriatic disease, it can lead to functional impairment, pain, discomfort, decreased quality of life and can also be a predictor for the development of arthritis. Early recognition of this condition can provide early and effective treatment and prevent structural impairment. This study aims to identify nail ultrasonographic characteristics in three groups: psoriasis (PsO), psoriatic arthritis (PsA) and controls patients, to determine if the ultrasonography (US) can identify early signs of nail psoriatic impairment or local inflammation. We conducted nail US to determine nail matrix resistance index (NMRI), nail bed resistance index (NBRI), and power Doppler (PD) and grayscale (GS) parameters in these 3 groups. Methods Single-center, cross-sectional study. GS, PD, and spectral doppler images of bilateral 2nd and 3rd fingernails were acquired from 35 PsO, 31 PsA, and 35 controls patients. An US equipment with an 18 MHz linear transducer for GS and 8.0 MHz for PD was used. PD, NMRI, NBRI, nail plate thickness (NPT), nail bed thickness (NBT), nail matrix thickness (NMT), and morphostructural characteristics of the trilaminar structure (TS) were evaluated in saved images, blind. Results Mean NMRI and NBRI did not differ between groups. Linear regression analysis detected no relationships between PsO or PsA and NMRI or NBRI. Nail PD grade did not differ between groups. Type I and IV TS changes were more frequent in PsO; types II and III changes were more frequent in PsA (p < 0.001). NPT was greater in PsA and PsO groups than controls: PsA 0.73 ± 0.14 mm, PsO 0.72 ± 0.15 mm, Controls 0.67 ± 0.10 mm (p = 0.001). Conclusion Echographic TS characteristics of the nail plate and NPT evaluated by GS are useful and can distinguish PsO and PsA nails from controls. NMRI, NBRI, and US nail microcirculation parameters could not distinguish psoriatic nails. Trial registration 72762317.4.0000.5327 (Certificate of Presentation of Ethical Appreciation – CAAE - Plataforma Brasil) Avaiable in https://plataformabrasil.saude.gov.br/login.jsf.

scholarly journals NINJA trial: should the nail plate be replaced or discarded after nail bed repair in children? Protocol for a multicentre randomised control trial

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e031552 ◽  
Author(s):  
Abhilash Jain ◽  
Amy Jones ◽  
Matthew D Gardiner ◽  
Cushla Cooper ◽  
Adam Sierakowski ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Nail Plate ◽  
Parent Satisfaction ◽  
Randomised Control Trial ◽  
Central Research ◽  
Site Infection ◽  
Nail Bed ◽  
Cosmetic Appearance ◽  
South Central ◽  
The Impact

IntroductionTrauma to the nail bed is the most common surgically treated paediatric hand injury. The majority of surgeons replace the nail plate after repairing the nail bed despite a lack of evidence to do so. Replacing the nail plate may be associated with increased postoperative infection. We will investigate the impact of replacing or discarding the nail plate on infection, cosmetic appearance, pain and subsequent healthcare use. The Nail bed INJury Analysis trial (NINJA) aims to answer the question of whether the nail plate should be replaced or discarded after surgical nail bed repair in children.Methods and analysisA two-arm parallel group open multicentre randomised control trial of replacing the nail plate or not, as part of a nail bed repair, will be undertaken in children presenting within 48 hours of a nail bed injury requiring surgical repair. The coprimary outcomes are: cosmetic appearance summary score at a minimum of 4 months and surgical site infection at around 7 days following surgery. Secondary outcomes are EuroQol EQ-5D-(Y); the pain intensity experienced at first dressing change; child/parent satisfaction with nail healing and healthcare resource use. We will recruit a minimum of 416 patients (208 in each group) over 3 years. Children and their parents/carers will be reviewed in clinic around 7 days after their operation and will be assessed for surgical site infection or other problems. The children, or depending on age, their parents/carers, will also be asked to complete a questionnaire and send in photos of their fingernail at a minimum of 4 months postsurgery to assess cosmetic appearance.Ethics and disseminationThe South Central Research Ethics Committee approved this study on 4 June 2019 (18/SC/0024). A manuscript to a peer-reviewed journal will be submitted on completion of the trial as per National Institute for Health Research publication policy. The results of this trial will substantially inform clinical practice and provide evidence on whether the practice of replacing the nail plate should continue at the time of nail bed repair.Trial registration numberISRCTN44551796.

Dermoscopy of the Nail Plate, Nail Matrix, and Nail Bed

Melanonychias ◽  
2017 ◽  
pp. 25-43
Author(s):  
Nilton Di Chiacchio ◽  
Diego L. Bet ◽  
Nilton Gioia Di Chiacchio
Keyword(s):  
Nail Plate ◽  
Nail Bed ◽  
Nail Matrix

scholarly journals Subungual glomus tumour excision: The nail plate flap technique

2017 ◽  
Vol 2 (3) ◽  
Author(s):  
Sandeep Mehrotra ◽  
Vikas Singh ◽  
Uday Singh Dadwal
Keyword(s):  
Nail Plate ◽  
Glomus Tumour ◽  
Nail Bed ◽  
Beneficial Effects ◽  
Flap Technique ◽  
Accurate Localization ◽  
Nail Deformity ◽  
Improved Outcomes ◽  
One Year

<p>Subungual glomus tumours, though rare, cause distressing symptoms and merit surgical treatment with minimal morbidity. Approaches to the nail bed over the years have varied from earlier nail excisions to trans/sub/periungal techniques. Nail plate preservation has beneficial effects on pain, and cosmesis and surgical modifications to ensure the same are desirable. We employed a simple nail preservation technique on six patients over the last seven years. After an accurate localization of the lesion based on pin test and MRI, a proximally-based nail plate flap was marked and elevated beyond the glomus. The tumour was removed through a linear nail-bed incision, following which the nail plate flap was reposited without suturing. All cases had gratifying relief of symptoms. Within a few weeks of the excision, no nail distortion was noticeable. No recurrences were noted on follow-up for one year. The nail flap transungal approach relies on accurate preoperative tumour localization. It ensures a protective post-operative cover with reduced pain. A minimalistic approach with no skin incisions ensures less morbidity and improved cosmesis with no nail deformity. The nail plate flap technique can be employed in selected cases for improved outcomes.</p>

scholarly journals Should the nail plate be replaced or discarded after nail bed repair in children? Nail bed INJury Analysis (NINJA) randomised controlled trial: a health economic and statistical analysis plan

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Jamie R. Stokes ◽  
May Ee Png ◽  
Abhilash Jain ◽  
Aina V. H. Greig ◽  
Beverly A. Shirkey ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Surgical Site Infection ◽  
Controlled Trial ◽  
Nail Plate ◽  
Site Infection ◽  
Nail Bed ◽  
Finger Nail ◽  
Cosmetic Appearance ◽  
Randomised Controlled ◽  
Post Randomisation

Abstract Background Nail bed trauma is one of the most common surgically treated paediatric hand injuries in the UK. Despite surgeons generally expressing a preference to replace the nail plate after repairing the nail bed, there is limited evidence to support this practice. We describe a statistical and health economic analysis plan (SHEAP) for the Nail bed INJury Analysis (NINJA) randomised controlled trial. Methods/design NINJA is a multicentre, pragmatic, superiority, parallel group randomised controlled trial of the treatment of nail bed injury in participants 16 years old or younger. The study aims to evaluate the efficacy and cost-effectiveness of replacing the nail plate compared to discarding it following the repair of a nail bed injury. Surgical site infection at 7–10 days post-randomisation and cosmetic appearance of the nail are the co-primary outcomes for NINJA. Surgical site infection at 7–10 days post-randomisation will be evaluated using a logistic regression model adjusting for site as the sole stratification factor and allowing for intra-site correlation. Cosmetic appearance will be assessed via the newly developed Oxford Finger Nail Appearance Score and will be evaluated by use of a Mann-Whitney U test. An ordinal logistic regression model will also be used to assess the Oxford Finger Nail Appearance Score, adjusting for site and allowing for intra-site correlation. Secondary outcomes are measured at 7–10 days and 4 months and include the EQ-5D-Y questionnaire, pain at first dressing change, cost-effectiveness, late surgical site infection, and participant/parent satisfaction with nail healing. Missing primary outcome data will be summarised by treatment arm and investigated through a sensitivity analysis. Full details of the planned methods of analysis and descriptive statistics are described in this paper. The NINJA study protocol has been published previously. Discussion The planned analysis strategy for the NINJA trial has been set out here to reduce the risk of reporting bias and data-driven analysis. Any deviations from the SHEAP described in this paper will be detailed and justified fully in the final report of the trial. Trial registration ISRCTN, ISRCTN44551796. Registered on 23 April 2018.

Medial plantar venous flap technique for volar oblique amputation with no defects in the nail matrix and nail bed

2010 ◽  
Vol 63 (11) ◽  
pp. 1870-1874 ◽  
Author(s):  
Toshiya Yokoyama ◽  
Yasuyoshi Tosa ◽  
Masatoshi Hashikawa ◽  
Satoshi Kadota ◽  
Yoshiaki Hosaka
Keyword(s):  
Nail Bed ◽  
Flap Technique ◽  
Nail Matrix ◽  
Venous Flap

scholarly journals Ultrasound Evaluation of the Effectiveness of the Use of Acitretin in the Treatment of Nail Psoriasis

2021 ◽  
Vol 10 (10) ◽  
pp. 2122
Author(s):  
Magdalena Krajewska-Włodarczyk ◽  
Zbigniew Żuber ◽  
Agnieszka Owczarczyk-Saczonek
Keyword(s):  
Morphological Changes ◽  
Nail Plate ◽  
Clinical Signs ◽  
Extensor Tendon ◽  
Control Group ◽  
Nail Bed ◽  
Nail Psoriasis ◽  
Ultrasound Evaluation ◽  
Tendon Thickness ◽  
Retinoid Treatment

The study aimed to evaluate the effect of retinoid treatment on the morphological changes in the nail apparatus in patients with nail psoriasis. Material and methods: 41 patients aged 32 to 64 with nail psoriasis, without clinical signs of psoriatic arthritis, started on acitretin 0.6 to 0.8 mg kg b.w./d, for six months and 28 people in the control group were included in the study. Both groups had ultrasound examination of fingernails and digital extensor tendon in the distal interphalangeal joints. In psoriatic patients, US examination was conducted before starting the treatment and after six months. A total of 685 nails were examined. Results: After six months of treatment, there was a reduction in the thickness of the nail bed and nail matrix (p = 0.046 and p = 0.031, respectively). The thickness of the nail plates decreased, although it was statistically insignificant (p = 0.059) and it was higher than in the control group (p = 0.034). The reduced severity of clinical nail changes after six months of retinoid treatment did not correlate with the reduction in extensor tendon thickness in any group of patients. Conclusions: In patients with nail psoriasis, acitretin treatment resulted in a rapid decrease in the thickness of the nail bed and matrix, but it did not affect the thickness of the nail plate after six months. There was no effect of acitretin on the digital extensor tendon thickness or the increased blood supply to the tendon area. The results of the study may indicate the usefulness of ultrasound nail examinations in patients with nail psoriasis not only to assess the advancement of morphological changes and response to treatment, but also to choose the potential treatment.

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