Clinical outcomes of the oblique V-Y advancement pulp flap for repair of lateral fingertip injuries

We report the use of obliquely oriented V-Y advancement pulp flaps to reconstruct 17 consecutive, lateral oblique fingertip traumatic defects over a 2-year period. All flaps survived completely with no bone protuberance, prominent scar or neuroma evident at an average follow-up of 11 months (range 7 to 19). Although there was no incidence of severe hook nail deformities, there were two patients who had residual mild hook nails, two with pulp/nail asymmetries and one with an ingrown nail. The mean static two-point discrimination was 3.6 mm (range 3 to 8) and the mean Semmes–Weinstein monofilament test score 3.9 g (range 2.44 to 4.56). No correlation was found between the flap obliquity angle and sensory test results. We recommend the obliquely oriented V-Y pulp flap as a reliable reconstructive option for the cover of lateral oblique fingertip defects. Level of evidence: IV

Immediate Nail Bed Graft on Exposed Distal Phalanx in Fingertip Injury

Fingertip injuries with nail bed defects have traditionally been covered with full- or split-thickness nail bed grafts. However, it was widely understood, without sufficient evidence, that graft take is difficult if the nail bed is grafted directly on the distal phalanx. This study reports two successful cases of nail bed graft on sterile matrix defects with exposed bare cortical bone. Two patients suffered a crush injury on their fingers. While there was no fracture, the distal phalanx was exposed with a nailbed defect. As the defect was too large for primary closure and too small for flap coverage, a sterile matrix nailbed graft was performed using the ipsilateral big toe. In both cases, damaged nails have grown fully, identical to the contralateral finger with smooth and flat regrowth of the nail and adherence of the growing nail. Both outcomes were graded as excellent according to Zook’s criteria. No major complication was found except for a minor ingrown nail on donor site in both cases. Even if there is a nail bed defect with exposure of cortical bone, successful nail reconstruction could be obtained through immediate nailbed graft on the exposed distal phalanx.

A Novel Use of Umbilical Perinatal Graft in Subungual Exostosis Resection

Nail pathologies have a broad range of origin and may sometimes be complicated in presentation or clinical course, specifically when the pathology remains recalcitrant after treatment. In this case report we discuss a pathologic disorder that was initially misdiagnosed as a pyogenic granuloma surrounding an ingrown nail but was later found to be a benign neoplastic bone growth, Dupuytren exostosis, also known as a subungual exostosis. Operative treatment was deemed appropriate for the patient, and the exostosis was resected, leaving a soft-tissue void at the distal toe. The remaining void was filled with a perinatal graft, the use of which has been deemed effective anecdotally in both chronic and acute lower-extremity wounds but has not been widely discussed in the lower-extremity literature. This graft was placed to aid in wound healing over a potentially difficult wound bed. As amniotic, chorionic, and umbilical grafts become more prevalent in lower-extremity surgery, its antitumor effects should be further explored and published. This is the first case report, to our knowledge, of the successful use of a perinatal graft in the setting of a bone tumor, and it demonstrates that certain benign neoplasms can be treated with resection and placement of a perinatal graft while helping to prevent chronic wounds at surgical sites.

ОГЛЯД ЗАГАЛЬНОПРИЙНЯТИХ МЕТОДИК ЛІКУВАННЯ ОНІХОКРИПТОЗУ

Introduction: According to existing views, the ingrown nail is one of the diseases that often occurs in surgical practice and causes considerable suffering in patients and significantly restricts them in the performance of professional duties; reduces the physical activity and psychoemotional tone of the patient.Aim: Given that the number of patients with ingrown nail is steadily increasing, that today there are about 200 surgeries in the ingrown nail, and many of them do not take into account the etiological and pathogenetic components. The author's team decided to research and review common methods of treatment of ingrown nailsMaterials and methods: A library fund was worked out regarding the problem of ingrown toenails. the workings out of clinics of Ukraine and other countries were worked outResults: Today, there are more than 150 methodological approaches to treating ingrown nail in the world. None of these procedures is Ideal for Achieving aesthetic results with low cost, recurrence and complication rates. Conclusions: The identified problems lead to the need to find a new less traumatic and economical method of treatment of ingrown nail, which will be characterized by rapid recovery of the patient and reduction of possible relapses.

Clinical and Sociodemographic Characteristics of Ingrown Nails in Children

Background: Ingrown nail is a condition frequently seen in children and adolescents, the pain from which can affect their daily living activities and school performances. The purpose of this study was to determine the clinical and sociodemographic characteristics of ingrown nails in children. Methods: The clinical and sociodemographic characteristics of patients aged 0 to 18 years presenting with ingrown nail were evaluated retrospectively from clinic records. Results: Sixty-two patients aged 3 to 18 years (mean age, 15 years; male to female ratio, 1.06) were enrolled. A total of 175 ingrown nails were evaluated (all of them were in the halluces, 54.3% of them were on the lateral margin). A positive family history of ingrown nail was present in 15.7%. High prevalences of incorrect nail cutting (72.1%), trauma (36.1%), poorly fitting shoes (29%), hyperhidrosis (12.9%), obesity (9.7%), and accompanying nail disorders (9.7%) were determined among the patients. Conclusions: This study revealed the clinical and sociodemographic characteristics of ingrown nails in children. These data will be useful in preventing the occurrence of ingrown nail by revealing and then eliminating predisposing factors.

Plastic surgery of nail folds combined with Arkada’s method in patient with ingrown nail – case report

Introduction: Ingrown nail (onychocryptosis) is a common condition in podiatric and surgical practices. It is usually chronic, recurrent, and affects every-day quality of life. Treatment can be divided into conservative and surgical methods and should be initiated by the former methods and followed by the latter if need be.Case report: The report describes the case of a patient with an ingrown toenail, who suffered from recurrent bouts of inflammation which were cured conservatively. The periods of relief were short-lasting, and thus he underwent two types of treatment simultaneously – surgical excision of the nail folds combined with Arkada’s method. This treatment achieved two goals – withdrawal of all symptoms and a good aesthetic effect. No recurrences were reported.