RU2820735C1 - Method for conservative treatment of onychocryptosis of first toe - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery, and can be used for treating onychocryptosis of first toe. A dry liner in the form of a strip of collagen haemostatic sponge is installed in the place of pathological nail ingrowth. On the first day, the thickness of the dry collagen sponge is 1 mm; after installation, it is wetted with an aqueous solution of lidocaine hydrochloride twice a day. On the second and third days, a dry collagen sponge with thickness of 1.5 mm is installed, after installation it is wetted with an aqueous solution of gentamycin sulphate twice a day. On the fourth and fifth days, a dry collagen sponge with thickness of 2.5 mm is placed; after installation, it is wetted twice a day with an aqueous solution of gentamycin sulphate. From the sixth to the tenth day, a dry collagen sponge with thickness of 3 mm is placed daily; after installation, it is wetted twice day with 1 ml of an alcohol solution of furacilin.

EFFECT: method enables gradually enlarging the space between the nail and the lateral cushion, reducing the pain syndrome and the risk of secondary infection by changing the nail growth by constantly increasing the pressure with the collagen haemostatic sponge.

1 cl, 2 ex

Description

Field of technology to which the invention relates

The invention relates to medicine, namely to surgery.

State of the art

Onychocryptosis - Ingrown nail - ingrowth of the nail plate into the lateral edge of the nail fold (most often on the big toe, usually the outer edge). Onychocryptosis is a common disease in the practice of outpatient surgeons. Clinically manifested by redness and swelling of the nail fold, the inflammation that occurs with onychocryptosis causes severe pain and significantly reduces the patient’s quality of life. The most common treatment for onychocryptosis is surgical removal of all or part of the nail. In this case, the cause of the disease is not eliminated and the process repeats.

Known (analogue) "Method of surgical treatment of ingrown toenails" (RF patent for invention No. 2139692 dated October 20, 1999). The method consists in the fact that “... the operation is limited to the separation of the nail plate and the periungual fold in contact with each other and the resection of the hypertrophied periungual fold hanging over the edge of the nail plate.”

This method has the following disadvantages:

– Removing part of the periungual fold can only temporarily eliminate the problem; in the future, the nail will re-grow.

Asprototypeyou can use a patent “Adhesive-plaster structure for the treatment of wounds caused by ingrown nails” (RF patent for invention No. 2717937 dated March 26, 2020). One of the options for implementing the device declared by the author is to introduce a foreign body into the area of onychocryptosis formation for a long time, which was widely used in outpatient paramedic practice during the First World War. In Soviet manuals for paramedical personnel (paramedic), from the mid-30s of the last century, strips of rubber and then latex were used as such a foreign body. Currently, this method is considered archaic and is not used in outpatient surgery.

This option for conservative treatment of onychocryptosis has the following disadvantages:

1) The introduction of a foreign body made of rubber or latex prevents ingrown nails in the first days from the start of treatment, but subsequently causes inflammation with the formation of a bedsore at the installation site;

2) Pain syndrome on the first day after the start of the manipulation;

3) Possible suppuration under the inserted foreign body.

Thus, the development of a new method for the conservative treatment of onychocryptosis of the first toe is required. In the claimed method, the listed disadvantages are eliminated.

Disclosure of the Invention

The objective of the invention is to treat onychocryptosis of the first toe using a conservative method.

Technical result The method is to ensure a gradual expansion of the space between the nail and the lateral ridge (due to a constant increase in pressure on the growing nail, the direction of its growth changes) against the background of a decrease in pain in the first day, the prevention of secondary infection and the formation of skin compaction at the site of the ingrown nail.

Carrying out the invention

The declared technical result can be achieved as follows:

- The patient is examined in accordance with the standards of medical care, medical documentation is filled out, and the presence of allergic reactions to drugs planned for use during treatment is determined. In the absence of contraindications, a decision is made to begin treatment.

- In accordance with the protocol adopted in this medical institution, the surgeon’s hand and the site of manipulation are treated with antiseptic means, and a sterile medical instrument is used.

- Under local anesthesia, a blunt extraction of the nail is performed in the area of its ingrowth into the lateral ridge; if necessary, necrotic areas of skin are removed, pus is evacuated; if there is a nail spike, it is removed with nippers.

- A decision is made on the possibility of implementing the claimed method or on the need for surgical removal of the nail.

- The method is implemented as follows: a dry collagen sponge 1 mm thick is taken from a sterile package, a strip of the required length and width is cut from it and installed between the nail and the nail fold at the site of the ingrowth being eliminated. After installing a strip of dry collagen sponge, it is moistened with an aqueous solution of lidocaine hydrochloride 80 mg, as a result of which the sponge increases in volume. When the sponge is re-wetted with an aqueous solution of lidocaine hydrochloride 80 mg, the volume of the sponge further increases, which leads to detachment of the nail from the site of its ingrowth, while there is no pain syndrome, since local anesthesia is performed.

- On the second day, a dry collagen sponge 1.5 mm thick is installed; when it is moistened with an aqueous solution of gentamicin sulfate 40 mg, the volume of the sponge increases, which leads to detachment of the nail from the site of its ingrowth; the presence of a broad-spectrum antibiotic prevents secondary infection of the site of ingrowth of the nail. When the sponge is re-wetted with an aqueous solution of gentamicin sulfate 40 mg, the volume of the sponge further increases, which leads to detachment of the nail from the site of its ingrowth. These manipulations are repeated on the third day.

- On the fourth and fifth days, all manipulations are repeated, but the thickness of the dry collagen sponge increases to 2.5 mm.

- During the period from the sixth to the tenth day of treatment, manipulations are carried out aimed at thickening and compacting the epithelial layer at the site of the ingrown nail, a dry collagen sponge 3 mm thick is installed daily, after installation it is moistened twice a day with 1 ml of an alcohol solution of furatsilin 1:1500.

- On the 11th day after the start of treatment, the patient’s direction of growth of the edge of the nail changes and a thickening of the skin forms at the site of potential formation of onychocryptosis. The treatment is completed.

The novelty of the proposed method lies in the fact that:

- For the first time, a gradual retraction of the nail that has grown into the lateral ridge is ensured due to the swelling of the collagen pad when it is wetted and a gradual increase in the thickness of the collagen pad when it is installed.

- For the first time, pain is relieved on the first day by providing constant local anesthesia.

- For the first time, re-infection of the ingrowth site is excluded due to local antibacterial therapy from the second to fifth days of treatment and due to the introduction of an antiseptic solution from the sixth to tenth days.

- For the first time after epithelization of the skin at the site of eliminated ingrown nail, thickening of the epithelization site is ensured through the use of an alcohol solution of furatsilin from the sixth to tenth day.

Distinctive features of the method

- a daily replaceable strip of collagen hemostatic sponge is used as a pad,

- the strip is installed in a dry state,

- on the first day, the thickness of the dry collagen sponge is 1 mm, after installation it is moistened twice a day with an aqueous solution of lidocaine hydrochloride 80 mg,

- on the second and third days, a dry collagen sponge 1.5 mm thick is installed, after installation it is moistened twice a day with an aqueous solution of gentamicin sulfate 40 mg,

- on the fourth and fifth days, a dry collagen sponge 2.5 mm thick is installed, after installation it is moistened twice a day with an aqueous solution of gentamicin sulfate 40 mg,

- from the sixth to the tenth day, a dry collagen sponge 3 mm thick is installed daily; after installation, it is moistened twice a day with 1 ml of an alcohol solution of furatsilin 1:1500.

The proposed method is illustrated by the following examples.

Example 1

An adult patient complained of pain in the area of the big toe of the right foot at rest, aggravated by walking. The duration of the disease is more than 10 years. Previously, surgical removal of an ingrown toenail was performed. The clinical picture resumed one year after the operation. Objectively there are signs of an ingrown toenail of the big toe of the right foot. The nail is deformed, the direction of nail growth is forward and outward. A decision was made on conservative treatment of onychocryptosis according to the proposed method on an outpatient basis.

The ingrown area is treated under sterile conditions, and the nail is removed using a blunt method. A dry collagen sponge was installed and manipulations were performed according to the proposed method. On the first, second, fourth and sixth days, all manipulations were performed by a surgeon; on the remaining days, all manipulations were performed by the patient independently. The necessary medications were given to the patient at each stage of treatment.

On the 11th day, diastasis formed in the area of the ingrown nail, the direction of nail growth changed, and an epithelial compaction formed on the lateral ridge at the site of the ingrown nail. Treatment of onychocryptosis. In long-term follow-up (12 months), no relapse occurred. The prognosis is favorable.

Example 2

An adult patient complained of pain in the area of the big toe of the left foot at rest, aggravated by walking. The duration of the disease is 3 years. Objectively there are signs of an ingrown toenail of the big toe of the left foot. The nail is deformed, the direction of nail growth is forward and outward. A decision was made to surgically treat onychocryptosis - removal of the nail on an outpatient basis.

The nail plate was removed in a classical manner under sterile conditions. Hemostasis. Wound management under a bandage. On the 14th day from the moment of surgery, the wound is clean, regeneration of the nail plate is determined. The patient was discharged with recovery.

At follow-up (7 months), there was a recurrence of onychocryptosis. Repeated surgery is required. The prognosis is doubtful.

Thus, under equal initial conditions, the use of the proposed technique made it possible to obtain a stable cure for onychocryptosis in long-term follow-up (12 months).

Claims (1)

A method of conservative treatment of onychocryptosis of the first toe, which consists of installing a gasket at the site of pathological ingrowth of the nail into the lateral roller, characterized in that a daily replaceable strip of collagen hemostatic sponge is used as a gasket, while the strip is installed in a dry state, on the first day the thickness of the dry collagen sponge is 1 mm, after installation it is moistened twice a day with an aqueous solution of lidocaine hydrochloride 80 mg, on the second and third days a dry collagen sponge 1.5 mm thick is installed, after installation it is moistened twice a day with an aqueous solution of gentamicin sulfate 40 mg, on on the fourth and fifth days, a dry collagen sponge 2.5 mm thick is installed, after installation it is moistened twice a day with an aqueous solution of gentamicin sulfate 40 mg, from the sixth to tenth days a dry collagen sponge 3 mm thick is installed daily, after installation it is wetted twice a day 1 ml alcohol solution of furatsilin 1:1500.