RU2403877C1 - Method of ingrown nail surgery - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery, can find application in treating an ingrown nail. Substance of the method consists in removal of the nail wall hypergranulations and ingrown nail plate, including tissue exposure to apparatuses generating physical fields. A leaf-shaped incision is made on the nail wall of the length of a nail plate combined with one-stage excision of hypergranulations. The second incision is made along the edge of an ingrown nail plate of the depth of a growth zone without dissection of the posterior nail wall. Thereafter, a separated portion of the nail plate with matrix is removed. For 20-30 seconds, the entire surface area of the nail bed and matrix wherefrom a portion of the nail plate is being removed, is exposed to low-frequency ultrasound. After sanitation and drainage procedures, an antiseptic dressing is applied as a tampon preferentially made of calcium alginate to fill the wound cavity tightly. Ultrasound frequency is 26.5 kHz.

EFFECT: use of the given invention eliminates recurrences, and also provides improved cosmetic effect.

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Description

The invention relates to medicine, specifically to surgery, and in particular to a method for radical surgery of an ingrown nail.

A known method of surgical treatment of an ingrown nail, consisting in the fact that under local anesthesia a longitudinal dissection of the ingrown nail is performed, retreating 2-3 mm from the ingrown edge. The dissected nail plate is twisted, the incision is deepened through the nail bed to the periosteum. A second arched incision through the lateral roller to the periosteum, connecting the top and bottom of the longitudinal section, excise a lunate flap. The edges of the wound are brought together by a bandage or sutures passing over the edge of the nail ("Big Medical Encyclopedia", M .: GNI "Soviet Encyclopedia", 1961, v.21, p.62).

The disadvantage of this method is the frequent cleavage of the nail platinum after surgery, as well as infectious complications leading to an increase in the healing time of the wound.

A known method of surgical treatment of ingrown nails with preservation of the nail plate, including the removal of inflamed tissue of the nail roll and the impact on the nail plate, excision of the nail bed under the nail plate, subsequent exposure of the periosteum, drawing perforations in the nail plate, applying sutures to the wound with the soft edges tissue under the nail plate and the application of an antiseptic dressing (E.A. Gorokhova et al. "Surgical treatment of ingrown nails. Plastic surgery in traumatology and orthopedics and ". St. Petersburg, 1995, pp. 93-94).

The disadvantages of this method include the possibility of delamination of the nail platinum during the puncture of its surgical needle and postoperative complications.

There is also known a method of surgical treatment of an ingrown nail, involving the removal of hypergranulations of the nail roll and the growing edge of the nail plate, including exposure to tissues with devices - generators of physical fields, while sorbent dressings are used as an antiseptic dressing, preferably containing therapeutic and prophylactic agents (RU 2155013 C1, 08.27.2000). The method involves the use of laser exposure, and sorbent wipes containing therapeutic and prophylactic agents containing copper and the Tykveol plant-derived antioxidant are used as an antiseptic dressing.

The disadvantages of the method include the possibility of relapse, pain during treatment in the preoperative and postoperative periods, significant swelling and exudation from the nail bed, in addition, the cosmetic effect is unsatisfactory.

The invention solves the problem of eliminating relapse of the disease, when stopping the pain syndrome, reducing edema and eliminating exudation from the nail bed, as well as improving the cosmetic effect.

The problem is solved in that a method of surgical treatment of an ingrown nail, involving the removal of hypergranulations of the nail roll and the growing edge of the nail plate, including exposure to tissues with devices - generators of physical fields, while sorbent dressings are used as an antiseptic dressing, preferably containing therapeutic and prophylactic means, characterized in that they perform a leaf-shaped incision along the periungual roller for the length of the nail plate with an instant excised using hypergranulations, then a second cut is made along the edge of the growing nail plate, to the depth of the growth zone without cutting the posterior nail roller, after which the cut-off part of the nail plate with the matrix is removed, and then processing with low-frequency ultrasound, simultaneously with the entire surface area, is performed for 20-30 seconds the nail bed and matrix, from which part of the nail plate was removed, and after sanitation and drainage of the wound, a tampon, preferably made of alginate, is used as an antiseptic dressing Alzen, which tightly fill the wound cavity. In addition, ultrasonic processing is carried out at a frequency of up to 26.5 kHz.

A comparison of the features of the claimed solution with the features of analogues and prototype indicates its compliance with the criterion of "novelty."

The features of the characterizing part of the claims solve the following functional tasks.

The signs "perform a leaf-shaped incision along the periungual roller to the length of the nail plate with simultaneous excision of hypergranulations" ensure the removal of inflamed tissues of the periungual roller.

The sign "make a second cut along the edge of the growing nail plate" provide the ability to remove the growing part of the nail.

Signs indicating a cut on the nail plate "to the depth of the growth zone", ensure that the growing part of the nail is cut off over its entire length.

Signs indicating a cut on the nail plate “without dissecting the posterior nail roll” minimize the length of the open area of the surgical wound and therefore exclude the appearance of scars in the growth zone (and causing cosmetic damage to the patient).

Signs indicating that “remove the cut off part of the nail plate with the matrix, provide a reduction in the width of the nail plate.

Signs indicating that “within 20-30 seconds they are treated with low-frequency ultrasound with a frequency of up to 26.5 kHz, simultaneously the entire surface area of the nail bed and matrix, from which part of the nail plate has been removed” provide uniform and short-term treatment of the affected areas inflammatory process with the energy of low-frequency ultrasonic vibrations, thereby blocking inflammatory processes, destroying pathogenic microflora and accelerating healing of the wound. The human ear perceives elastic waves propagating in the medium with a frequency of up to about 16 kHz; vibrations with a higher frequency are ultrasound (beyond hearing). Usually, the frequency band from 20 kHz and higher is considered the ultrasonic range.

The signs “after sanitation and drainage of the wound, use a tampon, preferably made of calcium alginate, which tightly fills the wound cavity, as an antiseptic dressing” provide quick healing of the wound while minimizing pain when replacing dressings.

The claimed invention is illustrated by drawings, in which Fig. 1 shows the first stage of the operation - the execution of the first cut, Fig. 2 shows the second phase of the operation - the execution of the second cut along the edge of the nail plate; figure 3 shows a view of the operating area after removing the cut-off growing zone of the nail plate; figure 4 shows a view of the surgical wound in the process of ultrasonic treatment; figure 5 shows a view of the surgical wound after plugging it; figure 6 shows the appearance of the nail before surgery; Fig.7 shows the appearance of the nail after surgery.

The drawings show the finger 1, matrix (growth zone) 2, the back nail roll 3, the nail plate 4, the periungual roller 5, the leaf-shaped section 6, the hypergranulation zone 7, the growing edge 8 of the nail plate 4, the surgical wound 9, the second section 10 (depth growth zones - L), the clipped part 11 of the nail plate with the matrix, the working end 12 of the waveguide tool, a tampon 13 made of calcium alginate, which tightly fills the cavity of the surgical wound 9.

Simultaneous operations on the side roller and nail plate give a positive effect only with a very small degree of damage to the matrix. This is due to the fact that usually the nail plate in this zone is deformed and curved in the plantar direction. To achieve a positive result, it is necessary, in addition to removing the lateral roller hypergranulations and resecting the nail plate, to completely remove the zone of its growth at the site of growth.

For work, we used the Caviton ultrasound apparatus, intended for the prevention and treatment of purulent wounds and wound infections of various origins and localization by treating them with low-frequency ultrasound energy both through intermediate liquid and consistent medicinal substances, as well as contact.

The device is manufactured in the climatic modification of the UHL location category 4.2 according to GOST R 50444. Depending on the perceived mechanical stresses, the device belongs to group 2 according to GOST R 504444. Depending on the electrical safety requirements, the device belongs to class B according to GOST R 50267.0. The device is intended for operation at an ambient temperature of + 10 ° С to + 35 ° С and a relative humidity of 80% at a temperature of + 25 ° С.

The device is powered by an alternating current main with a frequency of (50 ± 0.5) Hz and a voltage of 220 V ± 10%. The operating frequency of the device is (26.5 ± 1.5) kHz. The amplitude of the displacement of the working end of the waveguide-tool with its load on the air for the used waveguide-tool "TC" is 50 μm.

The power consumption of the device is not more than 200 VA.

The device consists of an ultrasonic generator, an acoustic unit and a set of waveguide instruments. The acoustic unit is a magnetostrictive transducer of electrical vibrations into mechanical ones and a conical-cylindrical hub glued to it. The acoustic unit is closed by a conical-cylindrical perforated casing. The waveguides used in the treatment are cylindrical rods made of titanium alloy with working ends of various configurations. To perform the operation, the TK waveguide tool is used, which is a single-wave cylindrical rod (⌀ = 4.5 mm) with a working end equipped with a cutting edge.

Intervention is carried out in a hospital setting. The essence of the operation consists in the partial surgical removal of the growing edge of the nail plate and hypergranulations and the subsequent processing of the nail bed and the matrix of the nail germ zone by ultrasound.

The operation is performed under general or local anesthesia. A hemostatic tourniquet is applied to the base of the finger. The surgical field is treated with a 70% solution of ethyl alcohol and 5% iodine solution (according to Pirogov). Surgery begins with local anesthesia. An anesthetic needle is used with a small diameter (from a 1.0 gram syringe), which is attached to a 10.0 gram syringe with a 1% novocaine solution. An injection is made into the soft tissues of the dorsal surface of the proximal phalanx on the sides of the base of the diseased finger. Moreover, the needle is gradually advanced during the injection onto the plantar side of the finger, sequentially filling the tissues with the drug mixture.

Next, a leaf-shaped incision is made along the periungual roller to the length of the nail plate (scalpel No. 15), while simultaneously excising hypergranulations. Then, a second incision is made along the edge of the growing nail plate with a “run” under the rear nail roller to the depth of the growth zone (matrix). After that, the lower jaw of the direct clamp of the Mosquito type is brought under the edge of the nail (from the cut off side), with the capture of the root part of the nail, and the upper one is brought along the surface of the edge of the nail and under the periungual roller. After these manipulations, a careful rotation of the closed clamp is made along the axis and the growing cut-off part of the nail plate is removed. Next, the nail bed and the sprout part of the nail (matrix) are treated with an ultrasonic waveguide for 20-30 seconds (depending on the thickness of the nail plate), which is inserted flat into contact with the wound surface being processed. After that, the wound is sanitized with a 3% hydrogen peroxide solution. It is then dried with sterile wipes and tamped either with a gauze ball with antibacterial ointments or (more preferably) with a swab made of calcium alginate. Then remove the hemostatic tourniquet and produce a bandaging of the finger.

The time of surgery, depending on the choice of anesthesia, ranged from 5 to 10 minutes.

The use of dressings with calcium alginate in the postoperative period is advisable, because, compared to conventional gauze dressings, when changing dressings, tissue impregnated with calcium alginate does not adhere to the wound, which allows it to be replaced painlessly and sparingly for the resulting granulations. The use of gauze dressings often delays the healing process. Calcium alginate fibers are a soft friable plate that easily simulates the shape of a wound. Upon contact with sodium salts, which are contained in the blood and wound secretion, the fibers swell and turn into a moist, hygroscopic gel that fills the wound. Due to the close contact of this dressing with wound surfaces, bacteria are absorbed from everywhere, including from the depth of the wound, and are reliably connected in the gel structure. This leads to an effective reduction in their number and helps to avoid reinfection. The wound cleans quickly. The gel-like consistency of a dressing with calcium alginate creates the effect of a moist environment that prevents the wound from drying out. There is a microclimate favorable for wound healing, which stimulates the formation of granulation tissue. Due to the formation of gel, the dressing does not stick to the wound, its change is painless. We believe that in children with an ingrown nail, it is necessary to use a bandage with calcium alginate as a tamponing material, for operations on an ingrown nail according to our technique, as well as in the subsequent postoperative period.

The following is a specific example of the implementation of the method.

Patient T., 12 years old, turned to the department of elective surgery with complaints of pain and ingrown nail plate in the area of the first toe of the right foot. Sick for two months. According to the patient, the above complaints appeared after cutting the nail plate. This made walking and wearing shoes difficult. An attempt to self-treat by dressing with Levomekol ointment did not bring any effect.

Objectively, from the lateral side of the nail roller there are hypergranulations, edema and hyperemia. The edge of the nail plate is immersed in hypergranulation. When pressing on the affected nail cushion and the nail plate, the patient notes severe pain, and pus is released from the gap of the paranasal sinus. Diagnosis: Ingrown nail (lateral margin) of the first toe of the right foot (Fig.6).

Protocol of operation No. 210 of 04/23/08. An operation was performed according to the developed technique. The postoperative period is smooth. Pain syndrome occurred only on the day of surgery. Signs of inflammation stopped on the second day after surgery. The wound healed by secondary intention.

March 14, 09 - 11 months after surgery (Fig.7). There are no complaints. Palpation is painless. The growth of the nail is correct, there are no inflammatory changes, deformation of the nail plate is not marked. Outcome: recovery. The use of low-frequency ultrasound made it possible to achieve a small degree of tissue injury, an excellent hemostatic effect, practically without narrowing the nail bed, a mild pain effect in the postoperative period, and most importantly, it made it possible to prevent a relapse of the disease.

Claims (2)

1. A method of surgical treatment of an ingrown nail, involving the removal of hypergranulations of the nail roll and the growing edge of the nail plate, including exposing the tissues to devices - generators of physical fields, using sorbent dressings as an antiseptic dressing, preferably containing therapeutic and prophylactic agents, characterized in that a leaf-shaped incision is made along the periungual roller along the length of the nail plate with simultaneous excision of hypergranulations, then they take a second cut along the edge of the growing nail plate, to the depth of the growth zone without cutting the posterior nail roll, after which the cut-off part of the nail plate with the matrix is removed, and then for 20-30 seconds they are treated with low-frequency ultrasound simultaneously over the entire surface area of the nail bed and matrix, with which part of the nail plate was removed, and after sanitation and drainage of the wound, a tampon is used as an antiseptic dressing, preferably made of calcium alginate, with which the cavity is tightly filled wounds. 2. The method according to claim 2, characterized in that the ultrasonic treatment is carried out at a frequency of up to 26.5 kHz.

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