DOI: 10.1097/01.prs.0000264656.75619.f2

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PMID: 18090805

Issn Print: 0032-1052

Publication Date: 2007/12/01


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Lateral Fold Rotational Flap Technique for Treatment of Ingrown Nail

Wael M. El-Shaer

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Author Information: welshaer@hotmail.com

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Excerpt

Onychocryptosis, commonly referred to as ingrown nail, is defined as the insertion of the nail plate into periungual tissues, leading to painful swelling, inflammation, infection, and the formation of granulation tissue in the nail walls.1 There are many therapeutic alternatives available for the management of onychocryptosis. A central problem with all of these therapeutic modalities is the high rate of recurrence, delayed wound healing, and prolonged discharge; the production of unsightly nail or scar; and restriction of normal activities.2
I have developed a new technique that includes surgical partial matricectomy followed by a lateral nail fold rotational flap. My aims are to improve exposure during partial matricectomy, preserve the integrity of the nail unit, minimize the recurrence rate, and improve the cosmetic outcome.
The first step after preparation and anesthesia is to clear any reactive granulation tissue in the vicinity of the nail fold by curettage or simple excision with scissors. A full-thickness cut using a no. 15 scalpel is made through the preplanned lines, as follows:
Elevation and immobilization of the extremity are recommended for 6 hours postoperatively, with dressing changes on the second day.
Reconstruction with flaps has been described in only two previous studies. In 1923, Ney3 described an operation based on two skin flaps of the entire surface on the affected side of the toe, but this procedure is too complicated and there is a high possibility of flap sloughing. The second technique, proposed by Harun et al.,4 involved partial matricectomy followed by a lateral fold advancement flap. Harun et al. achieved good cosmetic results, with an 8.1 percent recurrence rate and a 5.2 percent spicule formation rate.
I have achieved satisfactory results (Table 1), with a low recurrence rate (2.94 percent, in the form of a spicule formation), good cosmetic results, and high rates of patient and physician satisfaction. This new technique is an easy procedure with reproducible results. The uncomplicated, simple rotational flap offers perfect, wide exposure, so that the entire margin of the nail unit can be effectively and completely treated. The nail fold preservation and nail unit integrity achieved with this technique are of utmost importance, because of the ability for two-point discrimination, the protection of the distal phalanx, and the cosmetic appearance (Fig. 2). All of these are achieved with a rapid return to daily activities and a short wound-healing time.
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