A Zigzag Flap for Correcting a Nail Deformity Caused by Subungual Schwannoma

2021 ◽  
Vol 111 (4) ◽  
Author(s):  
AnLi Lee ◽  
Chi-Yuan Tzen ◽  
Chia-Meng Yu ◽  
Ming-Feng Tsai
Keyword(s):  
Nail Plate ◽  
Tumor Excision ◽  
Nail Bed ◽  
Nail Deformity ◽  
Complete Tumor

Subungual schwannoma is quite rare and often causes nail deformity and difficulty in wearing shoes. Complete tumor excision is the treatment of choice, and we advocate that restoring the nail appearance should be considered at the same time. We present the case of 43-year-old man with a big toe subungual schwannoma. We designed a zigzag incision method to excise the tumor and also corrected nail-bed deformity. The patient had a smooth recovery, and the nail plate regrew with a good appearance.

scholarly journals Subungual Glomus Tumor: A Review of 15 Cases Treated with Partial Nail Plate Excision Technique

2021 ◽  
Author(s):  
Mahmoud Farzan ◽  
Mahdi Neshan ◽  
Amir Reza Farhoud ◽  
Abbas Abdoli
Keyword(s):  
Glomus Tumor ◽  
Nail Plate ◽  
Tumor Location ◽  
Tumor Treatment ◽  
Nail Bed ◽  
Nail Deformity ◽  
Surgical Methods ◽  
The Matrix ◽  
The Mean

Background: Although there are various surgical methods for subungual glomus tumor treatment, there is no consensus on the optimal surgical approach. Methods: We analyzed the outcomes of 15 patients treated with partial nail plate excision technique. The medial or lateral section of the nail plate was excised longitudinally based on the tumor location. After incision of the nail bed and tumor removal, the matrix was repaired carefully. Results: In this study, 15 people, including 11 men and four women, were studied. The mean onset of symptoms until diagnosis was 88 months. In the postoperative evaluation, the mean follow-up was 20 months. Two patients had recurrent tumors, and one had postoperative nail deformity. Conclusion: Meticulous nail bed repair and complete tumor excision are key treatment points needed to prevent nail deformity and recurrence.  

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

2004 ◽  
Vol 94 (6) ◽  
pp. 578-582
Author(s):  
Thomas S. Roukis ◽  
Adam S. Landsman
Keyword(s):  
Nail Plate ◽  
Surgical Excision ◽  
Distal Phalanx ◽  
Great Toe ◽  
Nail Bed ◽  
Adipofascial Flap ◽  
Nail Deformity ◽  
Complete Surgical Excision ◽  
Surgical Options ◽  
Normal Architecture

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 (J Am Podiatr Med Assoc 94(6): 578–582, 2004)

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 A modified proximally based nail bed flap approach for benign subungual bone tumors in the distal phalanx

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901988378
Author(s):  
Seok Woo Hong ◽  
Jihyeung Kim ◽  
Seonpyo Jang ◽  
Min Ho Lee ◽  
Hyun Sik Gong ◽  
...  
Keyword(s):  
Tumor Recurrence ◽  
Bone Tumors ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Distal Phalanx ◽  
Level Of Evidence ◽  
Tumor Excision ◽  
Nail Bed ◽  
Cosmetic Outcomes ◽  
Complete Tumor

Background: Complete tumor removal and damaged nail bed repair are critical factors that determine the success of subungual tumor excision. We examined a modified proximally based nail bed flap approach for excision of subungual bone tumors of the distal phalanx and present cases where this approach was used, along with postoperative functional and cosmetic outcomes. Methods: Twenty-four benign subungual bone tumors, identified from 23 patients (9 males and 14 females), were included in this study. All patients underwent tumor excision by the modified proximally based nail bed flap approach. Pain was assessed using a numeric rating scale, and cosmesis was self-assessed using a visual analog scale preoperatively and 1 year postoperatively. We measured sensation of the involved digit tip, relative to opposite-side sensation, using static and moving two-point discrimination and Semmes–Weinstein monofilament tests 1 year postoperatively. Lastly, we assessed postoperative nail deformities and tumor recurrence as potential surgical complications. Results: Mean pain severity and cosmesis were significantly improved 1 year postoperatively. There were no significant differences in the digit tip sensation between the involved and the opposite-side digits 1 year postoperatively. We observed one case of tumor recurrence and four cases of postoperative nail deformities. Conclusions: The modified proximally based nail bed flap approach showed satisfactory functional and cosmetic outcomes. This approach enables a low rate of recurrence after removal of benign subungual bone tumors in the short term and cosmetically superior nail bed repair. Level of evidence: Therapeutic, IV

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.

Recurrent Onychomadesis of the Toenails in Children and Adults: A Case Series

2021 ◽  
pp. 1-3
Author(s):  
Dana Sous ◽  
Michela V.R. Starace ◽  
Lu Chen ◽  
Elizabeth L. Nieman ◽  
Milan J. Anadkat ◽  
...  
Keyword(s):  
Risk Factors ◽  
Side Effects ◽  
Treatment Strategy ◽  
Viral Infections ◽  
Nail Plate ◽  
Case Series ◽  
Drug Side Effects ◽  
Case Presentation ◽  
Nail Bed ◽  
Physical Trauma

<b><i>Introduction:</i></b> Onychomadesis occurs when the nail plate separates from the nail matrix and nail bed, eventually leading to shedding of the nail. This condition has been attributed to viral infections, autoimmune disorders, drug side effects, and physical trauma. A subset of patients has a recurrent form of onychomadesis without a clear trigger; this phenomenon is not well characterized in the literature. <b><i>Case Presentation:</i></b> We present a case series of pediatric and adult patients with recurrent toenail onychomadesis in order to better characterize the disorder and explore possible etiologies, risk factors, and treatments. <b><i>Discussion/Conclusion:</i></b> For the cases herein, we propose microtrauma associated with footwear as the underlying etiology given the periodicity of nail shedding, exclusion of other etiological factors, and presence of predisposing risk factors in certain patients. Many patients saw improvement with application of urea 40% cream, suggesting this can be a valuable part of a treatment strategy, in addition to minimizing injury to involved digits.

scholarly journals Ciclopirox and Efinaconazole Transungual Permeation, Antifungal Activity, and Proficiency To Induce Resistance in Trichophyton rubrum

2019 ◽  
Vol 63 (10) ◽  
Author(s):  
Daniela Monti ◽  
Diletta Mazzantini ◽  
Silvia Tampucci ◽  
Alessandra Vecchione ◽  
Francesco Celandroni ◽  
...  
Keyword(s):  
Antifungal Activity ◽  
Trichophyton Rubrum ◽  
Nail Plate ◽  
Content Type ◽  
Nail Bed ◽  
Antimycotic Activity ◽  
Frequent Relapses ◽  
Induce Resistance ◽  
Over Time

ABSTRACT Onychomycosis is a nail fungal infection, mostly caused by dermatophytes. The treatment efficacy is impaired by difficulties of reaching effective drug levels at the site of infection; frequent relapses occur after cessation of antifungal therapy. The aim of the study was to compare two commercial products containing ciclopirox or efinaconazole for antimycotic activity and antifungal drug resistance. A study of permeation and penetration through bovine hoof membranes, as a nail model, was performed to evaluate the antimycotic activity of permeates against clinical isolates of selected fungi, and the frequency of spontaneous in vitro Trichophyton rubrum-resistant strains was assessed by broth microdilution assays. The results suggest that ciclopirox creates a depot in the nail, leading to a gradual release of the drug over time with action on both the nail plate and bed. Conversely, efinaconazole, mildly interacting with nail keratin, mainly exerts its antifungal activity in the nail bed. However, in the case of T. rubrum, the antifungal activities of the drugs in the nail plate seem comparable. Finally, efinaconazole showed a potential for induction of resistance in T. rubrum, which may limit its efficacy over time. Ciclopirox did not show any potential to induce resistance in T. rubrum and appears endowed with a more complete activity than efinaconazole in the management of onychomycosis as the nail keratin is a substrate for the growth of fungal cells, and the availability of drug in large concentration just in the nail bed may not be sufficient to guarantee the complete eradication of pathogens.

Human nail bed‐derived decellularized scaffold regulates mesenchymal stem cells for nail plate regeneration

2019 ◽  
Vol 13 (10) ◽  
pp. 1770-1778 ◽  
Author(s):  
Yaling Yu ◽  
Haomin Cui ◽  
Demin Zhang ◽  
Bo Liang ◽  
Yimin Chai ◽  
...  
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Nail Plate ◽  
Nail Bed ◽  
Human Nail ◽  
Decellularized Scaffold

Subungual glomus tumours of the hand: diagnosis and outcome of the transungual approach

2009 ◽  
Vol 34 (5) ◽  
pp. 685-688 ◽  
Author(s):  
I. J. LEE ◽  
D. H. PARK ◽  
M. C. PARK ◽  
N. S. PAE
Keyword(s):  
Local Recurrence ◽  
Severe Pain ◽  
Nail Plate ◽  
Glomus Tumour ◽  
Nail Bed ◽  
Surgical Microscope

We report 17 patients with a subungual glomus tumour. All complained of pain and tenderness when touched, and nine patients experienced severe pain in the cold. A transungual approach with nail plate avulsion on one side was used in all cases. A surgical microscope was used to localise and dissect the tumour and to repair the nail bed and matrix. This method has produced good results, without local recurrence or postoperative nail plate deformity.

Operative Treatment of the Ingrown Toenail With a Less-Invasive Technique: Flashback to the Original Winograd Technique

2017 ◽  
Vol 11 (2) ◽  
pp. 138-141 ◽  
Author(s):  
Yalkin Camurcu ◽  
Hakan Sofu ◽  
Ahmet Issin ◽  
Nizamettin Kockara ◽  
Hakan Saygili
Keyword(s):  
Nail Plate ◽  
Case Series ◽  
Operation Time ◽  
Invasive Technique ◽  
Nail Bed ◽  
Less Invasive ◽  
Ingrown Toenail ◽  
Case Series Study ◽  
Stage 1

Objective: The aim of this study was to evaluate the results of the partial nail plate excision and curettage of nail bed and matrix (the original Winograd technique) in patients with ingrown toenail. Materials and methods:Patients with ingrown toenail who were treated surgically from May 2014 to June 2015, with a minimum follow-up of 1 year were included in this study. Those who had previous ingrown toenail surgery were excluded. Partial nail plate excision with curettage of nail bed and nail matrix was performed for all patients. Rifampicin soaked sterile gauze was placed onto the wounds after the procedure. Results:The study population included 100 males and 89 females with a mean age of 30 years. Eight patients (4.2%) had stage 1, 71 patients (37.6%) had stage 2, and 110 patients (58.2%) had stage 3 ingrown toenails. The mean operation time was 4.8 minutes. No complication occurred during the procedure. It was found that 15 patients (7.9%) had recurrence during the follow-up. Conclusion:The original Winograd technique is an efficient and less-invasive technique for the treatment of ingrown toenail, with lower rates of recurrence and complications. Levels of Evidence: Therapeutic Case Series Study, Level IV

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