RU2794036C2 - Method of combined treatment of ingrown nail - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to outpatient surgery. An economical resection of the edge of the nail plate with a width of 5 mm is carried out. The germinal matrix is removed with a Volkmann spoon. At the same time, the germinal matrix is first removed, then 1 ml of Verrukacid is applied on the bed of the removed matrix for 3 minutes. After that, the matrix bed is re-cleaned with a small curet, and a control treatment of the bed is performed for 3 minutes with 1 ml of Verrukacid.

EFFECT: method allows to minimize the pain syndrome after surgical treatment, minimizing postoperative complications, minimizing the likelihood of recurrence of an ingrown nail due to surgical and chemical effects on the germinal matrix, reducing the period of disability by a factor of three compared to previous treatment in the presented patients, and improving the quality of life.

1 cl, 3 ex, 9 dwg

Description

The invention relates to medicine, in particular to outpatient surgery and can be used in the treatment of an ingrown nail (onychocryptosis), including the recurrence of the disease.

A known method of treating an ingrown nail by complete or partial excision of the nail plate according to G. Dupuytren or W. Schmiden [Big medical encyclopedia. In 30 volumes. Ch. ed. B.V. Petrovsky - 3rd ed. - M.: Soviet encyclopedia, 1981. - v.17. - With. 46-47; Pautkin Yu.F., Malyarchuk V.I. Polyclinic surgery. - Moscow, 2005. - p. 233-234], with the possible removal of the corresponding part of the matrix [Popkov O.V., Results of surgical treatment of an ingrown nail, ways to improve them / O.V. Popkov, S.A. Alekseev, S.O. Popkov // Military medicine. - 2013. - No. 3. - S.54-56.].

There is also known a method for the treatment of an ingrown nail, in which the excision of the nail plate is supplemented by various effects on the germinal matrix, from chemical ablation to destruction by laser radiation [Baran R., Haneke E., Richert B. Pincer nails: definition and surgical treatment// Dermatol . Surg. - 2001. - Vol.27, No. 3. - P. 261-26 Boberg J.S., Frederiksen M.S., Harton P.M. Scientific analysis of phenol nail surgery// J. Am. Podiatr. Med. Assoc. - 2002. - Vol.92, No. 10. - P. 575-579; Petushkov D.V. Surgical treatment of an ingrown nail using a carbon dioxide laser: abstract of diss. PhD M. State Scientific Center for Laser Medicine, 2003].

These methods are quite widely used in outpatient surgery, but are characterized by some disadvantages:

• disfiguring defect;

• the possibility of delamination of the nail plate when it is sutured with the skin periungual roller;

• high risk of disease recurrence.

These methods are taken as a prototype. The invention is based on the task of preventing the recurrence of the disease and reducing the duration of treatment. This problem is solved by the fact that a combined surgical and chemical effect is proposed on the ingrown nail, namely:

- after an economical marginal resection of the nail plate (5 mm) and removal of the matrix with a Volkmann spoon, chemical biolysis is performed twice with one milliliter of Verrukacid, containing 58.8% phenol, 3.92% metacresol in 95% alcohol solution, which has a cauterizing effect on body tissues.

The proposed method of combined treatment of ingrown nails is carried out as follows. The operating field is treated with an official alcoholic solution of iodine. Conduction anesthesia according to Lukashevich - Oberst is performed with 4.0 ml of 2% Novocaine solution. A tourniquet is applied to the base of the finger to reduce bleeding of the wound. The ingrown edge of the nail plate (5 mm) is economically excised along with the germinal matrix without an incision in the proximal periungual ridge. Using a clip of the "Mosquito" type, the excised edge of the nail plate is removed. The Volkmann spoon removes the matrix and granulation tissue. On the bed of the removed matrix, a special applicator included in the pharmaceutical package of the drug is applied for 3 minutes with 1 ml of the Verrukacid preparation, avoiding contact with healthy tissues. After the initial coagulation of the tissues, the matrix bed is re-cleaned with a Volkmann spoon and a control treatment of the bed with 1 ml for three minutes is performed with the Verrukacid preparation.

The method is illustrated in the following figures 1-3: FIG. 1: view of the first toe with an ingrown toenail before surgery, where 1 is the germinal matrix; 2 - inflamed periungual roller, 3 - nail plate.

Fig. 2: view of the first toe after removal of the ingrown edge of the nail plate, granulation tissue and matrix with a Volkmann spoon and double chemical ablation of the bed with Verrukacid, where 1 is the germinal matrix (the rest), 3 is the nail plate, 4 is the nail bed, 5 - matrix bed. Fig. 3: view of the first finger 14 days after the combined treatment of an ingrown nail, where 1 is the germinal matrix, 3 is the nail plate.

In the practice of medicine, the use of the drug "Verrukacid" is known to remove benign tumor-like skin formations (papillomas). However, the use of the drug for the treatment of an ingrown nail by its effect on the growth zone of the nail plate is proposed for the first time.

The signs that allow recognizing the claimed "Method of combined treatment of ingrown nail" as corresponding to the criteria of "novelty" and "inventive step" are the following:

• a new technique for the treatment of ingrown toenails (onychocryptosis) was developed, including in case of recurrence of the disease, using chemical biolysis with Verrukacid.

Using the proposed method of combined treatment of ingrown nails allows to achieve the following results:

• minimize pain after surgical treatment;

• minimize postoperative complications;

• minimize the likelihood of recurrence of an ingrown nail due to surgical and chemical effects on the germinal matrix;

• reduce three times the period of incapacity for work compared with previous treatment in the presented patients;

• improve the quality of life.

Clinical examples:

1. Patient D., born in 1987, a worker by profession. Ambulatory card LLC "Ortogrupp" No. 1/21. Diagnosis: Ingrown toenail of the first toe of the right foot. Third relapse (Fig. 4).

Fig. 4. The third recurrence of the ingrown nail of the first toe of the right foot. Inflamed lateral periungual fold. Scar of the proximal periungual fold.

Surgery on December 1, 2019. Economical removal (5 mm) of the lateral edge of the nail plate.

Under local anesthesia according to Lukashevich - Oberst, 4 ml of a 2% solution of Novocain with a tourniquet applied to the base of the first toe of the right foot, the ingrown edge of the nail plate was excised sparingly (5 mm). The corresponding fragment of the germinal matrix was removed with a Volkmann spoon, the bed of which was coagulated with 1 ml of the drug "Verrukacid" for three minutes. Volkmann's spoon removed the coagulate from the germinal matrix bed with repeated biolysis for three minutes. An aseptic bandage was applied.

I started work on the second day after the operation. Dressings and observation for seven days. Examined for control after 6 months, no recurrence of the disease (Fig. 5). The result is rated as good. Fig. 5. Examination of the patient 6 months after the combined treatment of the ingrown nail of the first toe of the right foot. There is no relapse.

2. Patient A., born in 1978, lawyer by profession. Ambulatory card LLC "Ortogrupp" No. 1/11. Diagnosis: ingrown nail of the first toe of the right foot (Fig. 6).

Fig. 6. Ingrown nail of the first toe of the right foot. Inflammation of the lateral periungual ridge.

Conservative treatment for four years is not effective. Operation on November 06, 2019. Economical removal (5 mm) of the lateral edge of the nail plate.

Under local anesthesia according to Lukashevich - Oberst, 4 ml of a 2% solution of Novocain with a tourniquet applied to the base of the first toe of the right foot, the ingrown edge of the nail plate was excised sparingly (5 mm). The corresponding fragment of the germinal matrix was removed with a Volkmann spoon, the bed of which was coagulated with 1 ml of the drug "Verrukacid" for three minutes. Volkmann's spoon removed the coagulate from the germinal matrix bed with repeated biolysis for three minutes. An aseptic bandage was applied.

She started work on the second day after the operation. Dressings and observation for seven days. Examined for control after 6 months, no recurrence of the disease (Fig. 7). The result is rated as good. Fig. 7. Examination of the patient 6 months after the combined treatment of the ingrown nail of the first toe of the right foot. There is no relapse.

3. Patient G., born in 2003, student. Ambulatory card LLC "Ortogrupp" No. 1/2. Diagnosis: ingrown nail of the first toe of the left foot. Second relapse. Onychorrhexis (Fig. 8).

Fig. 8. Ingrown nail of the first toe of the left foot. Onychorrhexis after surgical treatment (relapse).

Operation on December 17, 2019. Economical removal (5 mm) of the lateral edge of the nail plate.

Under local anesthesia according to Lukashevich - Oberst, 4 ml of 2% solution of Novocaine with a tourniquet applied to the base of the first toe of the left foot, the ingrown edge of the nail plate was excised sparingly (5 mm). The corresponding fragment of the germinal matrix was removed with a Volkmann spoon, the bed of which was coagulated with 1 ml of the drug "Verrukacid" for three minutes. Volkmann's spoon removed the coagulate from the germinal matrix bed with repeated biolysis for three minutes. An aseptic bandage was applied.

I started studying on the second day after the operation. Dressings and observation for seven days. Examined for control after 5 months, no recurrence of the disease (Fig. 9). The result is rated as good. Fig. 9. Examination of the patient 5 months after the combined treatment of the ingrown nail of the first toe of the right foot. There is no relapse.

Claims (1)

A method for the combined treatment of an ingrown nail, including an economical resection of the edge of the nail plate 5 mm wide, removal of the germinal matrix with a Volkmann spoon, characterized in that the germinal matrix is first removed, then 1 ml of Verrukacid is applied to the bed of the removed matrix for 3 minutes, after which the bed the matrix is re-cleaned with a Volkmann spoon and a control treatment of the bed is carried out with 1 ml for 3 minutes with the Verrukacid preparation.

Images