Kemal GÖKKUŞ, Murat SAYLIK, Ergin SAĞTAŞ, Ahmet Turan AYDIN

Tırnak Batması Ingrown Nail Tedavisinde Modifiye Winograd Tekniği Sonuçlarımız

Amaç: Tırnak batması ingrown nail , günümüz toplumunda ayağın en fazla ağrı ve rahatsızlıkla sonuçlanan, iş gücü kaybına yol açan durumudur.Tırnak batması konservatif tedavi yöntemleri ile tedavi edilemezse cerrahi tedavi seçeneği önemli bir alternatiftir. Modifi ye winograd tekniği son yıllarda populer olmuş önemli bir cerrahi tedavi yöntemidir.Makalede dokümente edilen 21 olgunun 24 tırnağına uygulanan modifi ye Winograd tekniğinin klinik sonuçlarını, nüks şeklini, oranını ve hasta memnuniyetini değerlendirmeyi amaçladık.Gereç ve Yöntemler: Tırnak batması şikayeti ile başvurup konservatif tedaviye yanıt vermeyen, 21 hastanın 12 kadın /9 erkek 24 tırnağına winograd tekniği ile kısmi tırnak çekimi ve yatak revizyonu uygulandı. Hastalar ortalama 20 Min/Maks: 6 / 63 ay ay takip edildi.Pre/Post operatif VAS skorları Wilcoxon Signed Ranks Test ile değerlendirildi. Pre/Post operatif VAS skorlarının cinsiyete göre farklılık gösterip göstermediği Mann Witney U testi ile değerlendirildi. Pre/Post operatif VAS skorlarının yaş ile bağıntısı Pearson Korelasyon testi ile değerlendirildi. Nüks ve memnuniyetsizlik oranları ortalama değer olarak sunuldu.Bulgular: Preoperatif ortalama VAS skorlaması 7,48 SD: 1,159 , Postoperatif ortalama VAS skorlaması 1,48 SD: 1,05 , ortalama yaş 35,44 SD:11,67 . Pre/Postoperatif VAS skorları arasındaki düşüşün istatistiki olarak anlamlı olduğu saptandı Wilcoxon Signed Ranks Test, p

Anahtar Kelimeler:

Tırnak batması, Modifi ye Winograd tekniği, Onikokriptoptosis

The Clinical Results of the Modifi ed Winograd Technique in the Treatment of Ingrown Nails

Objective: In-grown nail is the most common problem that causes pain and discomfort in the foot.If the conservative treatment fails, the surgery is the option of the treatment. Modifi ed Winograd technique is the popular and the preffered surgical treatment method nowadays.21 documented patients with 24 nails were operated with the modifi ed Winograd technique. We aimed to evaluate the clinical results, satisfaction rate, and recurrence rate of the patients in this study. Material and Methods: The patients who were resistant to conservative treatment were included in this study. The modifi ed Winograd technique was utilized in a total of 21 patients female 12/male 9 .The mean follow-up period was 20 months Min/Max: 6/63 months .Pre /Post operative changes in VAS scores were evaluated with the Wilcoxon signed Rank test. The existence of a difference in Pre /Post operative VAS scores linked with gender were evaluated by the Mann-Whitney U test. The correlation between the Pre /Post operative VAS scores and age was evaluated with the Pearson correlation test. The recurrence rate and dissatisfaction from the surgery were reported directly Results: The mean pre-operative VAS score was 7.48 SD:1.159 , The mean Post -operative VAS score was 1.48 SD:1.05 . The mean age was 35.44 SD:11.67 . The mean change in pre/post operative VAS score was found to be statistically signifi cant Wilcoxon signed Rank test, P

Keywords:

Ingrown nail, Modifi ed Winograd Technique, Onychocryptosis,

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1. Eisele SA.Conditions of the toenails. Orthop Clin North Am 1994;25(1):183-8.
2. Sugden P, Levy M, Rao GS. Onychocryptosis-phenol burn fi asco. Burns 2001;27(3):289-92.
3. Ikard RW. Onychocryptosis. J Am Coll Surg 1998;187(1):96-102.(3)
4. Fulton GJ, O’Donohoe MK, Reynolds JV, Keane FB, Tanner WA. Wedge resection alone or combined with segmental phenolization for the treatment of ingrowing toenail. Br J Surg 1994;81(7):1074-5.
5. Van der Ham AC1, Hackeng CA, Yo TI.The treatment of ingrowing toenails. A randomised comparison of wedge excision and phenol cauterisation. J Bone Joint Surg Br 1990;72(3):507-9.
6. Pearson HJ, Bury RN, Wapples J, Watkin DF. Ingrowing toenails: is there a nail abnormality? A prospective study. J Bone Joint Surg Br 1987;69(5):840-2.
7. Ohtsuka H. How far does an ingrown toenail enlarge? Ann Plast Surg 2000;44:649-50.
8. Murray WR. Onychocryptosis: principles of nonoperative and operative care. Clin Orthop Relat Res 1979;(142):96-102.
9. Kuru I, Sualp T, Ferit D, Gunduz T.Factors affecting recurrence rate of ingrown toenail treated with marginal toenail ablation. Foot Ankle Int 2004;25(6):410-3.
10. Antrum RM. Radical excision of the nailfold for ingrowing toenail. J Bone Joint Surg Br 1984;66(1):63-5.
11. Zadik FR. Obliteration ofthe nail bed ofthe great toe without shortening the terminal phalanx. J Bone Joint Surg [Br]. l950;32-B:66-7
12. Ilfeld FW. Ingrown toenail treated with cotton collodion insert. Foot Ankle 1991; 11(5):312-3.
13. Antrum RM. Radical excision of the nailfold for ingrowing toenail. J Bone Joint Surg Br 1984;66(1):63-5.
14. Watkin DF. Management of ingrowing toenail. Br J Surg 1989;76(12):1353.
15. Winograd AM. A modifi cation in the technique of operation for ingrown toe-nail Jama 1929;92:229-30.
16. Heifetz CF. Ingrown toenail-a clinical study. Am J Surg 1937; 38:298-315.
17. Dereli T, Özyurt S, Öztürk A, Erboz S. Tırnak batması: Parsiyel matrisektomi/fenolizasyon kombinasyonu ile tedavisi. Turkderm 1995;29:151-4.
18. Murray WR. Management of ingrowing toenail. Br J Surg 1989;76(9):883-5.
19. Reijnen JAM, Goris RJA. Conservative treatment of ingrowing toenails. Br J Surg 1989;76(9):955-7.
20. Grieg JD, Anderson JH, Ireland AJ, Anderson JR.The surgical treatment of ingrowing toenails. J Bone Joint Surg Br 1991;73(1):131-3.
21. Kayalar M, Bal E, Toros T, Ozaksar K, Gürbüz Y, Ademoğlu Y.Results of partial matrixectomy for chronic ingrown toenail. Foot Ankle Int 2011;32(9):888-95.
22. Uruç V, Canseven N, Selçuk CT, Dönmez M. Partial wedge resection of nail, nail bed and nail matrix in ingrown toenail treatment. Klinik ve Deneysel Araştırmalar Dergisi. 2010;1(1): 37-40.
23. Hyder N.Ingrowing toe nails: The extent of the germinal matrix. J Bone Joint Surg Br 1994;76(3):501-2.
24. Winograd AM. A modifi cation in the technic of operation for ingrown toe-nail. J Am Podiatr Med Assoc 2007;97(4):274-7.
25. Hausere E. Diseases of the Foot, Philadelphia: WB Saunders, 1939.
26. Heifetz CJ: Operative management of ingrown toenail. J Missour Med Assoc 1945;42:213-6.
27. Lewin P. The Foot and Ankle. Philadelphia, Lea & Febiger, 1947.
28. Supran RJ. Podiatric Surgery. Cleveland: Ohio College of Podiatry, 1967.
29. Amberry TR. Foot Surgery, in Principles and Practice of Podiatry, Weinstein F (ed). Philadelphia: Lea & Febiger, 1968: 138
30. Dockery GL. Nails, In: McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery, 3rd Ed, ed by AS Banks, MS Downey, DE Martin, et al, p 203, Lippincott Williams & Wilkins, Philadelphia, 2001.
31. Aydin N, Kocaoğlu B, Esemenli T. Partial removal of nail matrix in the treatment of ingrowing toe nail. Acta Orthop Traumatol Turc 2008;42(3):174-7.
32. Kose O, Guler F, Gurcan S, Arik HO, Baz AB, Akalin S. Cosmetic results of wedge resection of nail matrix (Winograd technique) in the treatment of ingrown toenail. Foot Ankle Spec 2012;5(4):241-4.
33. Bos AM, van Tilburg MW, van Sorge AA, Klinkenbijl JH. Randomized clinical trial of surgical technique and local antibiotics for ingrowing toenail. Br J Surg 2007;94(3):292-6.
34. Dovison R, Keenan AM.Wound healing and infection in nail matrix phenolization wounds. Does topical medication make a difference? J Am Podiatr Med Assoc 2001;91(5):230-3.
35. Kimata Y, Uetake M, Tsukada S, Harii K.Follow-up study of patients treated for ingrown nails with the nail matrix phenolization method. Plast Reconstr Surg 1995;95(4):719-24.
36. Légaré F1, Dubé S, Naud A, Laperrière L, Turcot L. Recurrence and satisfaction levels following onysectomy with or without phenolization. Can Fam Physician. 1999;45:926-31.
37. Sugden P, Levy M, Rao GS. Onychocryptosis-phenol burn fi asco. Burns 2001;27(3):289-92.
38. Çetinus E, Uzel M, Bigiç E, Şaşmaz S, Arıcan Ö, Karaoğuz A. Results of the Mogensen’s lateral wedge resection technique in the treatment of ingrown toenail. Eklem Hast Cerrahisi 2007;18(3):116-20.
39. Harold B. Kitaoka. Master Techniques in Orthopaedics Surgery. The Foot and Ankle. Lippincott Williams and Wilkins. 2013: 3-10.
40. Eskitaşçıoğlu T, Altıparmak M. Partial Matricectomy and Foldplasty for the Management of Ingrown Toenails: Surgical Technique. Turkiye Klinikleri Journal of Medical Sciences 2010.30(2):820-824 · DOI: 10.5336/ medsci.2009-13500
41. Huang JZ, Zhang YJ, Ma X, Wang X, Zhang C, Chen L. Comparison of wedge resection (Winograd procedure) and wedge resection plus complete nail plate avulsion in the treatment of ingrown toenails. J Foot Ankle Surg. 2015 May-Jun;54(3):395-8. doi: 10.1053/j.jfas.2014.08.022.