BİLSEV İNCE, MEHMET DADACI, FATMA BİLGEN, Serhat YARAR

Comparison between knot and Winograd techniques on ingrown nail treatment

Objective: The aim of this study was to compare the Winograd and knot techniques based on efficiency, complication rate, surgery time, and amount of local anesthetic required. This study also aimed to determine the etiology of ingrown nails, whether due to involvement of the nail or soft tissue.Methods: Seventy-five patients with a total of 90 ingrown nails (stages 2 and 3) who presented at our clinic between 2012-2014 were included in this study. Patients were divided into 2 groups: those treated with the knot technique and those treated with the Winograd technique. Patients in both groups were evaluated for the amount of local anesthetic required, intraoperative pain, effectiveness of preventing/stopping hemorrhage, surgery time, complications, postoperative nail size, recurrence, nail deformities, and secondary surgery rates.Results: The mean surgical time, relapse rate, number of additional surgeries required, and amount of local anesthetic were significantly greater in the Winograd group than in the knot group. The mean nail diameter was significantly decreased, with a mean of 3 mm in the Winograd group. No statistically significant differences were found between the groups in the incidence of infection, intraoperative pain, hematoma, or nail deformity.Conclusion: This study demonstrated that the knot technique, consisting of wedge excision of soft tissue without affecting the nail itself, is a simple technique to treat ingrown nails with a lower complication rate and shorter surgical time. We believe that successful treatment of ingrown nails depends only on excision of soft tissue, with no need to operate on the nail bed

___

Eskitasoglu T, Altiparmak M. Partial matricectomy and foldplasty for the management of ingrown toenails: Surgi- cal technique. Turkiye Klinikleri J Med Sci 2010;30:820- 4.

Heidelbaugh JJ, Lee H. Management of the ingrown toe- nail. Am Fam Physician 2009;79:303-8.

Dadaci M, Ince B, Altuntas Z, Kamburoglu HO, Bitik O. Skin bridging secondary to ingrown toenail. Pak J Med Sci 2014;30:1425-7.

Erturk C, Karakurum HG. Results of the Winograd tech- nique in the treatment of ingrowing toe nail. [Article in Turkish] Gaziantep Tıp Dergisi 2009;15:19-22.

Gur G. Nail surgery for beginners. [Article in Turkish] Turkderm 2010;44:123-7.

Zuber TJ. Ingrown Toenail Removal. Am Fam Physician 2002;65:2547-50.

Ince B, Dadaci M, Altuntas Z. Knot technique: a new tre- atment of ingrown nails. Dermatol Surg 2015;41:250-4.

Woo SH, Kim IH. Surgical pearl: nail edge separation with dental floss for ingrown toenails. J Am Acad Derma- tol 2004;50:939-40.

Di Chiacchio N, Belda W Jr, Di Chiacchio NG, Kezam Gabriel FV, de Farias DC. Nail matrix phenolization for treatment of ingrowing nail: technique report and recur- rence rate of 267 surgeries. Dermatol Surg 2010;36:534-7.

Boztepe G, Karaduman A, Atakan N. Plastic tube met- hod for ingrown toenail: preliminary study. Turkderm 2006;40:63-5.

Ceilley RI, Collison DW. Matricectomy. J Dermatol Surg Oncol 1992;18:728-34.

Foulston J. Ingrowıng toe nail. In : Helal B, Wilson D, (eds) The foot. Newyork: Churchill Livingstone; 1988;2:858- 67.

Aydin N, Kocaoğlu B, Esemenli T. Partial removal of nail matrix in the treatment of ingrowing toe nail. [Article in Turkish] Acta Orthop Traumatol Turc 2008;42:174-7.

Uruc V, Canseven N, Selcuk CT, Donmez M. Partial wed- ge resection of nail, nail bed and nail matrix in ingrowing toenail treatment. [Article in Turkish] Klinik Deneysel Araştırmalar Dergisi 2010;1:37-40.

Korkmaz M, Colgecen E, Erdogan Y, Bal A, Ozyurt K. Teenage patients with ingrown toenails: treatment with partial matrix excision or segmental phenolization. Indian J Dermatol 2013;58:327.

Kayalar M, Bal E, Toros T, Ozaksar K, Gürbüz Y, Ade- moğlu Y. Results of partial matrixectomy for chronic ing- rown toenail. Foot Ankle Int 2011;32:888-95.

Peyvandi H, Robati RM, Yegane RA, Hajinasrollah E, Toossi P, Peyvandi AA, et al. Comparison of two surgical methods (Winograd and sleeve method) in the treatment of ingrown toenail. Dermatol Surg 2011;37:331-5.