RU2786471C1 - Method for treating an ingrown nail using laser radiation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery, and can be used to treat an ingrown nail using laser radiation. Laser destruction of the nail matrix is carried out using a light guide inserted all the way into the pocket formed after the removal of the lateral part of the nail plate. Exposure to laser radiation is carried out at three to five points of the growth zone of the nail from the ingrown side, the tissue of the lateral periungual ridge after laser destruction and excision of its tissues is additionally subjected to polishing by contact vaporization with laser radiation to healthy tissues. Exposure to laser radiation is carried out by a diode infrared laser with a wavelength of 915-1064 nm. The impact of laser radiation on the nail matrix is carried out by radiation with a power of 3-4 W in continuous mode, the duration of exposure at each point is 2-4 seconds. Laser destruction and excision of the tissues of the lateral periungual ridge and grinding of its surface is carried out for 30-90 seconds by radiation with a power of 4-6 W in a pulsed mode with a pulse and pause duration of 50-100 ms and 10-30 ms, respectively.

EFFECT: method provides minimally traumatic treatment that does not have age restrictions and excludes relapses due to the effect of laser radiation on the nail matrix, performed using a light guide inserted all the way into the pocket formed after removal of the side part of the nail plate.

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Description

SUBSTANCE: invention relates to medicine, namely to surgery, and may be applicable for surgical treatment of an ingrown nail.

The prior art method of radical treatment of an ingrown nail is known, including the removal of inflamed tissues of the nail fold, exposure to the nail plate, excision of the nail bed under the nail plate, subsequent exposure to the periosteum, making perforated holes in the nail plate, suturing the wound with soft tissue edges under the nail plate and applying an antiseptic dressing, while the inflamed tissues of the nail fold and the growing edge of the nail plate are removed by longitudinal evaporation with a focused laser beam, the excision of the nail bed under the nail plate is carried out with a focused laser beam, the matrix bed and matrix are evaporated with a focused laser beam running parallel to the nail phalanx, the impact on the periosteum is carried out with a defocused laser beam, perforations in the nail plate are applied with a laser beam, and dialdehyde cellulose wipes containing copper and vegetable antioxidant are used as an antiseptic dressing. origin "tykveol" (see. patent RU No. 2155013, IPC: A61B 18/20, A 61L 15/40; F61 L 15/44, publ. 27.08.2000).

This known method solves the problem of preventing postoperative complications and recurrence of the disease, as well as reducing the duration of treatment.

However, this method does not indicate the type of laser radiation, modes, power and operating time of the laser and methods of exposure remotely or by contact, which makes it impossible to reproduce this technique. It is on these data that the result of treatment and postoperative recovery depends. In addition, this method involves the excision of the nail bed under the nail plate through an additional incision, followed by exposure to the periosteum and suturing the wound with the soft tissue edge under the nail plate, which violates the integrity of the tissues of the distal phalanx of the finger, increases the surgical injury, and lengthens the healing time.

The above factors contribute to slowing down the repair of tissues of the periungual bed and increasing the duration of physical rehabilitation - up to two weeks.

A known method for the surgical treatment of an ingrown nail in children, selected as the closest analogue, includes a marginal resection of the nail plate and an incision of the posterior nail ridge on the affected side along the same line with the proposed line of resection of the nail plate by 1 cm, while the Volkmann spoon removes necrotic masses, granulation tissue at the site of nail plate ingrowth and expose the germinal matrix. After that, the edges of the surgical wound are slightly opened with tweezers, and having well visualized the germinal matrix, its laser destruction is performed, while laser destruction is carried out with a portable contact laser scalpel with a flexible light guide, irradiation with a wavelength of 0.97 μm and a power of 1.7 W is formed. laser destruction paths, which have a grayish color and visible recesses, are laid sequentially one after another, forming a platform - a zone of laser tissue destruction, the depth and color of the grooves determine the boundaries of the laser exposure (see patent RU No. 2695308, IPC: A61V 17/00 ; A61B 18/20, published 07/22/2019).

The technical result, which is directed by this known method, is to reduce the risk of recurrence of the disease due to a radical effect on the affected tissue.

As the applicant points out, when using the known method, the patients did not have a single case of recurrence of the disease. The period of postoperative wound healing averaged 14-18 days, which, according to the developers of the known method, is associated with a more radical effect on the tissues of the laser beam. Patients usually complained of pain on the first day after surgery. As a rule, a single anesthesia was enough.

Inflammation of the tissues of the lateral nail fold and the posterior nail fold around the incision site lasted about 14 days. The severity and duration of the inflammatory process depended on the degree of the ingrown nail (in the third degree more than in the second) and on the severity of the local infectious process.

According to the applicant, the use of the proposed known method reduces the risk of recurrence of the disease, but increases the healing time of the postoperative wound. Therefore, the use of the proposed method is advisable in patients:

- With the third degree of ingrown nail

- With a pronounced local infectious process

- With recurrence of the ingrown nail.

Thus, the known method has limitations on its use, does not completely exclude, but only reduces the risk of recurrence, has a long period of postoperative wound healing and is quite traumatic, since it involves a deep incision of the nail fold from the affected side along the same line with the proposed resection line of the nail. plates, mechanical removal of granulation tissue and necrotic masses with a Volkmann spoon, as well as exposure of the nail matrix for its visualization when processed with a laser scalpel.

The use of a power of 1.7 W in continuous mode of a portable diode laser scalpel with a radiation wavelength of 0.97 μm is not always sufficient, it requires a long exposure time. This power has been tested in the treatment of children, which does not exclude the possibility that it may be insufficient for coagulation and sanitation when working with adult patients with a large amount of granulation and dense fibrous tissue. According to the known method, tissue dissection and exposure of the matrix are required to remove the matrix area adjacent to the resected nail plate with a laser, which creates additional surgical trauma.

As the creators of this well-known method themselves indicate, its use reduces the risk of recurrence of the disease, but increases the healing time of the postoperative wound.

Thus, the technical result, to which the claimed invention is directed, is the creation of a method for the treatment of an ingrown nail, which is minimally traumatic, does not have age restrictions and excludes relapses.

This technical result is achieved by the fact that the method of treating an ingrown nail using laser radiation, including marginal resection of the nail plate of the lateral part of the nail from the side of the ingrowth, performed under local anesthesia, separation from the adjacent tissues and removal of the cut-off part of the nail plate, laser destruction of the nail matrix from the side of the ingrown and laser excision of the granulation and altered inflammatory tissue of the lateral periungual ridge, according to the invention, laser destruction of the nail matrix is carried out using a light guide inserted all the way into the pocket formed after the removal of the lateral part of the nail plate, exposure to laser radiation is carried out at three to five points of the nail matrix with sides of ingrowth, the tissue of the lateral periungual ridge after laser destruction and excision of its tissues is additionally subjected to polishing by contact vaporization with laser radiation to healthy tissues, exposure to laser radiation m is carried out with a diode infrared laser with a wavelength of 915-1064 nm, while exposure to laser radiation on the nail matrix is carried out by radiation with a power of 3-4 W in continuous mode, the duration of exposure at each point is 2-4 seconds, laser destruction and excision of tissues of the lateral periungual ridge and grinding its surface is carried out for 30-90 seconds by radiation with a power of 4-6 W in a pulsed mode with a pulse and pause duration of 50-100 ms and 10-30 ms, respectively.

The applicant has found that the implementation of the impact of laser radiation on the nail matrix precisely by laser destruction, performed using a light guide inserted all the way into the pocket formed after the removal of the side part of the nail plate, makes it possible to achieve the claimed technical result, namely, to minimize the trauma of the procedure. This is ensured by the fact that the tissues above the matrix zone are not dissected and healing is faster.

And the implementation of exposure to laser radiation precisely at three to five points of the growth zone from the side of the ingrowth allows for reliable destruction of the matrix of the pathologically growing part of the nail and to exclude the recurrence of the disease.

Additional surface polishing after laser excision of the lateral periungual ridge, due to the sanitation and alignment of the lateral nail bed, allows you to remove the focus of infectious inflammation, straighten, and normalize the structure of the skin around.

The period of wound healing averages up to 13 days, which is 2-5 days less than in the closest analogue (14-18 days).

Applicants experimentally selected modes of laser exposure, which are optimal. So, at high power and longer exposure time, a strong tissue burn is possible, which will increase the healing time and increase the likelihood of cicatricial changes; at lower powers, the processing time increases, there is a possibility of incomplete destruction of the matrix in the area of ingrown nail plate.

The claimed method is illustrated in Fig. 1 and 2. In FIG. 1 shows a diagram of the incision of the nail plate (marginal resection) to the growth zone of the lateral part of the nail plate from the ingrown side. Dotted line - cut line of the nail plate for subsequent removal of the ingrown part of the nail. In FIG. 2 - shows the location of three points of laser radiation exposure during interstitial laser coagulation of the growth zone carried out at three points: the first point is the corner, the second point is the center (between the start and end points of exposure), the extreme point is near the nail. Gray color indicates the removed part of the nail plate. 1, 2, 3 - points of exposure to laser radiation when the light guide is inserted into the pocket formed after the removal of the nail plate

The claimed method is carried out as follows.

The method is carried out on an outpatient basis, the patient is placed on his back, the surgical field is treated with any surgical antiseptic. Anesthesia is carried out by the method of local infiltration anesthesia in the amount of 1-2 ml (depending on the size of the finger) of any anesthetic for local anesthesia. Pointed small scissors make an incision of the nail plate (marginal resection) to the growth zone of the lateral part of the nail plate from the ingrown side. With a mosquito-type clamp, the part cut off from the nail plate is separated from the adjacent tissues, then captured and removed (Fig. 1).

The light guide is inserted into the pocket formed after the removal of the lateral nail plate (into the matrix zone) until it stops. Interstitial laser coagulation of the growth zone is carried out at three to five points: the first point is the corner, the second and subsequent points are the center, the extreme point is near the nail. (Fig. 2). Radiation power 3-4 W. Exposure at each point for 2-4 seconds. At the same time, the integrity of the skin and soft tissues above the matrix is not violated, therefore, there is no need to suture.

The pathologically altered tissue of the lateral periungual ridge is additionally subjected to contact laser destruction and excision of tissues with laser surface resurfacing by contact vaporization to healthy tissues. Power 4-6 W in pulsed mode. Pulse duration 90-100 ms, pauses 10-30 ms. The procedure execution time is from 30-90 seconds. This achieves sanitation and alignment of the lateral nail bed. Postoperative anesthesia is not required. A bandage is applied with an antibacterial ointment (Oflomelid, Levomekol) or Baneocin powder.

Examples of specific implementation.

Example 1. Patient K. 18 years old. Diagnosis: recurrent ingrown toenails of the 1st fingers of the right and left foot. In the anamnesis, the removal of the nail plates was performed twice with recurrence. The operation was performed on an outpatient basis: marginal resection of the nail plates from the side of the ingrowth, marginal laser destruction of the nail matrix of the 1st toe of the right and left foot from the side of the ingrowth, anesthesia was performed by local infiltration anesthesia in the amount of 1 ml of 1% lidocaine for each finger. With pointed scissors, a marginal resection of the nail plate was performed up to the matrix of the lateral part of the nail plate from the ingrown side. The mosquito-type clamp was used to separate from the underlying tissues, and then the cut-off part of the nail plate was captured and removed. Next, the light guide was introduced into the pocket formed after the removal of the side of the nail plate, until it stops. Laser destruction of the matrix zone was carried out at three points: the first point is the corner, the second point is the center, the extreme point is near the nail. The diode laser "Milon Lakhta" was used, with a wavelength of 970 nm in continuous mode, the radiation power was 4 W continuously. Exposure at each point for 3 seconds. Laser removal of granulations and fibrosis of the lateral periungual fold was performed, then laser surface resurfacing was performed by contact vaporization to healthy tissues in a pulsed mode, a Milon Lakhta diode laser, a wavelength of 970 nm, a power of 4 W, a pulse-pause ratio of 100:10 ms, execution time 60 s.

Postoperative anesthesia was not required. A sterile dressing with Baneocin was applied. Postoperative period without complications. Dressings with Baneocin powder. The pain was gone in 2 days. Return to the normal mode of exercise on the 7th day, healing on the 10th day. Under observation for 12 months. There was no relapse.

Example 2. Patient G., 16 years old. Diagnosis: recurrent ingrown toenail of the 1st toe of the right foot. In the anamnesis, the removal of the nail plate was performed twice, relapses. The operation was performed on an outpatient basis: marginal resection of the nail plate, laser destruction of the marginal matrix of the nail of the 1st toe of the right foot from the side of ingrowth, laser removal of granulations and fibrosis of the lateral periungual fold, surface grinding by contact vaporization to healthy tissues. Anesthesia was carried out by the method of local infiltration anesthesia in the amount of 1 ml of 1% lidocaine. With pointed scissors, a marginal resection of the nail plate was performed up to the growth zone of the lateral part of the nail plate from the ingrown side. The mosquito-type clamp was used to separate from the underlying tissues, and then the cut-off part of the nail plate was captured and removed. Next, the light guide is inserted into the pocket formed after the removal of the side nail plate, until it stops. Laser destruction of the nail matrix was carried out at 4 points: the first point is the corner, the second and subsequent points are the center, the extreme point is near the nail. We used a diode laser "Milon Lakhta", with a wavelength of 915 nm in continuous mode, radiation power of 3 W continuously. Exposure at each point for 4 seconds. We performed laser removal of granulations and fibrosis of the lateral periungual ridge, then laser surface resurfacing by contact vaporization to healthy tissues in pulsed mode, diode laser "Milon Lakhta", wavelength 915 nm, power 6 W, pulse-pause ratio 90:30 ms, in within 30 s.

Postoperative anesthesia was not required. A sterile bandage with Oflomelid ointment was applied. Postoperative period without complications. Dressings with Oflomelid ointment. The pain was gone in 2 days. Return to the normal mode of exercise on the 7th day, healing on the 11th day. Under observation for 6 months. Correctly formed nail, no recurrence.

Example 3. Patient K., aged 23. Diagnosis: recurrent ingrown toenail of the 1st toe of the right foot. In the anamnesis, the removal of the nail plate was performed, recurrence. The operation was performed on an outpatient basis: marginal resection of the nail plate, laser destruction of the marginal matrix of the nail of the 1st toe of the right foot from the ingrowth side.

Anesthesia was carried out by the method of local infiltration anesthesia in the amount of 1 ml of 2% lidocaine. With pointed scissors, a marginal resection of the nail plate was performed up to the growth zone of the lateral part of the nail plate from the ingrown side. The mosquito-type clamp was used to separate from the underlying tissues, and then the cut-off part of the nail plate was captured and removed.

The light guide was introduced into the pocket formed after the removal of the side nail plate, until it stops. Conducted interstitial laser destruction of the nail matrix at four points: the first point - the corner, the second and third points - the center, the extreme point - near the nail. A diode laser "Milon Lakhta" was used, with a wavelength of 1064 nm in continuous mode, a radiation power of 3 W continuously. Exposure at each point for 3 seconds.

Laser removal of hypergranulations and fibrosis of the lateral periungual fold was performed, then laser surface resurfacing was performed by contact vaporization to healthy tissues, the Milon Lakhta diode laser, wavelength 1064 nm, power 6 W, pulse-pause ratio 50:30 ms.

Postoperative anesthesia was not required. A sterile bandage with Oflomelid ointment was applied. Postoperative period without complications. Dressings with Oflomelid ointment. The pain was gone in 2 days. Complete healing for 12 days. Under observation for 12 months. Correctly formed nail, no recurrence.

Example 4. Patient B., 19 years old. Diagnosis: recurrent ingrown toenail of the 1st toe of the right foot. In the anamnesis, the removal of the nail plate was performed, recurrence is observed with ingrown nails on both sides. The operation was performed on an outpatient basis: bilateral marginal resection of the nail plate, interstitial laser destruction of the marginal matrix of the nail of the 1st toe of the right foot on both sides.

Anesthesia was carried out by the method of local infiltration anesthesia in the amount of 2 ml of 1% lidocaine. With pointed scissors, a marginal resection of the ingrown nail plate was performed up to the matrix of the lateral part of the nail plate on both sides. The mosquito-type clamp was used to separate from the underlying tissues, and then the cut-off parts of the nail plate were captured and removed.

The light guide was introduced into the pocket formed after the removal of the side of the nail plate, until it stops. Interstitial laser destruction of the nail matrix was performed from the medial side at five points: the first point - the corner, the second, third and fourth points - the center, the extreme point - near the nail, from the lateral side at three points. A diode laser "Milon Lakhta" was used, with a wavelength of 1064 nm in continuous mode. Radiation power 4 W continuously. Exposure at each point for 2 seconds. Laser removal of inflamed and fibrosed tissues of the lateral periungual fold was performed, then laser surface resurfacing was performed by contact vaporization to healthy tissues in a pulsed mode, Milon Lakhta diode laser, wavelength 1064 nm, power 4 W, pulse-pause ratio 100:10 ms . The duration of the procedure is 90 seconds. Postoperative anesthesia was not required. A sterile dressing with Levomekol ointment was applied. Postoperative period without complications. Dressings with Levomekol ointment. The pain was gone in 2 days. Healing for 12 days. Under observation for 10 months. Correctly formed nail, no recurrence.

Claims (1)

A method for treating an ingrown nail using laser radiation, including marginal resection of the nail plate of the lateral part of the nail from the side of the ingrowth, performed under local anesthesia, separation from the adjacent tissues and removal of the cut-off part of the nail plate, laser destruction of the nail matrix from the side of the ingrowth, and laser removal of the granulation and altered inflammatory tissue of the lateral periungual fold, characterized in that laser destruction of the nail matrix is carried out using a light guide inserted all the way into the pocket formed after the removal of the lateral part of the nail plate, laser radiation is applied at three to five points of the growth zone of the nail from the ingrown side, the tissue of the lateral After laser destruction and excision of its tissues, the periungual ridge is additionally subjected to polishing by contact vaporization with laser radiation to healthy tissues, exposure to laser radiation is carried out with a diode infrared laser of length waves of 915-1064 nm, while the impact of laser radiation on the nail matrix is carried out by radiation with a power of 3-4 W in continuous mode, the duration of exposure at each point is 2-4 seconds, laser destruction and excision of the tissues of the lateral periungual ridge and grinding of its surface is carried out for 30-90 seconds by radiation with a power of 4-6 W in a pulsed mode with a pulse and pause duration of 50-100 ms and 10-30 ms, respectively.

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