Ali ŞİŞMAN, Rıdvan ÖNER, Özgür AVCİ, Serdar Kamil ÇEPNİ

Tırnak Batması Cerrahisinde Parsiyel Matrisektomi Sonrası Sadece Küretaj Yöntemi ile Küretaj ve Elektrokoterin Birlikte Kullanıldığı Yöntemin Karşılaştırılması

Amaç: Tırnak batması iş gücü kayıplarına neden olan çok yaygın bir hastalıktır. Cerrahi tedavide farklı teknikler tanımlanmış olsa da en sık tercih edilen yöntemlerden biri parsiyel matriksektomidir. Bu çalışmanın amacı; tırnak batması cerrahisinde parsiyel matriksektomiye ek olarak kullanılan sadece küretaj tekniği ile küretaj ve elektrokoterin (C&E) birlikte kullanıldığı tekniği karşılaştırmaktır. Gereç ve Yöntem: Bu retrospektif çalışmada 2018-2022 yılları arasında tırnak batması nedeniyle ameliyat edilen olgular değerlendirildi. Sadece küretaj uygulanan 43 olgu ve C&E uygulanan 35 olgu çalışmaya dahil edilerek iki grup oluşturuldu. Gruplar; operasyon süresi, operasyon sonrası komplikasyonlar ve klinik sonuçlar açısından karşılaştırıldı. Bulgular: Gruplar arasında yaş, cinsiyet, etkilenen taraf, batık ayak tırnağı sınıflandırması, takip süresi, ameliyat süresi ve iyileşme süresi açısından fark saptanmadı.. Küretaj grubunda nüks oranı daha yüksekti. (p=0,020) Küretaj grubunda 9 (%20,9), C&E grubunda 1 (%2,9) olguda nüks görüldü. Küretaj grubunda eritem süresinin daha uzun olduğu (p<0.001) ve daha fazla pansuman ihtiyacı olduğu görüldü (p<0.001). C&E grubunda daha uzun süre seröz eksüda görüldü (p=0,007). Takip süresince hiçbir olguda enfeksiyon saptanmadı. Sonuç: Bu çalışmaya göre; tırnak batması cerrahisinde parsiyel matriksektomiye ek olarak uygulanan küretajın dezavantajları daha yüksek nüks oranı, daha uzun eritem süresi ve daha fazla pansuman ihtiyacı olması iken C&E'nin dezavantajı daha uzun süre seröz eksüda görülmesidir. Enfeksiyon oranları ve iyileşme süresi açısından iki teknik arasında fark yoktur.

Anahtar Kelimeler:

Tırnak batması, matrisektomi, küretaj, elektrokoter

A Comparison of Curettage Only and Curettage with Electrocautery After Partial Matrixectomy for Ingrowing Toenail

Aim: Ingrowing toenail is a very common disease which causes workforce losses. Although different techniques have been described in surgical treatment, one of the most frequently preferred methods is partial matrixectomy. The aim of this study was to compare the two techniques of curettage only and curettage together with electrocautery(C&E) used in addition to partial matrixectomy in ingrowing toenail surgery. Methods: Patients who were operated for ingrown nails between 2018 and 2022 were evaluated retrospectively. Two groups were formed of 43 patients applied with curettage only and 35 patients applied with C&E. The groups were compared in respect of operating time, postoperative complications and clinical results. Results: No significant difference was determined between the groups in respect of age, gender, affected side, classification, follow-up time, surgical duration and recovery time. Recurrence rate was higher in the curettage group (p=0.020) It occurred in 9 (20.9%) cases in the curettage group, while it occurred in 1 (2.9%) case in the C&E group. In the curettage group, the duration of erythema was observed to be significantly longer (p<0.001) and there was a need for more dressings (p<0.001). In the C&E group, serous exudate was seen for a longer period (p=0,007). Conclusion: The disadvantages of curettage applied in addition to partial matrixectomy in ingrown toenail surgery are, a higher rate of recurrence, longer duration of erythema, need for more dressings while the disadvantage of C&E is the longer duration of serous exudate. In respect of infection rates and time to recovery, no difference was determined between the two techniques.

Keywords:

ingrown nail, matrixectomy, currettage, electrocautery,

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1. Pavotbawan K, Müller TS. [Ingrown toenails]. Ther Umsch. 2020 Jun 1;77(5):227–33.
2. Park DH, Singh D. The management of ingrowing toenails. BMJ. 2012;344:e2089.
3. Martínez-Nova A, Sánchez-Rodríguez R, Alonso-Peña D. A new onychocryptosis classification and treatment plan. J Am Podiatr Med Assoc. 2007;97(5):389–93.
4. Andreassi A, Grimaldi L, D’Aniello C, Pianigiani E, Bilenchi R. Segmental phenolization for the treatment of ingrowing toenails: a review of 6 years experience. J Dermatolog Treat. 2004;15(3):179–81.
5. Agarwal P, Kukrele R, Sharma D. In-growing toe nail results of segmental matrix excision. J Clin Orthop Trauma. 2020;11:865–70.
6. Lin YC, Su HY. A surgical approach to ingrown nail: partial matricectomy using CO2 laser. Dermatol Surg. 2002;28(7):578–80.
7. Karacan E, Ertilav D. Comparison of Vandenbos procedure or Winograd method for ingrown toenail. Jt Dis Relat Surg. 2021;32(2):414–9.
8. Acar E. Winograd Method Versus Winograd Method With Electrocoagulation in the Treatment of Ingrown Toenails. J Foot Ankle Surg. 2017;56(3):474–7.
9. Camurcu Y, Sofu H, Issin A, Kockara N, Saygili H. Operative Treatment of the Ingrown Toenail With a Less-Invasive Technique: Flashback to the Original Winograd Technique. Foot Ankle Spec. 2018;11(2):138–41.
10. Ozan F, Doğar F, Altay T, Uğur SG, Koyuncu Ş. Partial matricectomy with curettage and electrocautery: a comparison of two surgical methods in the treatment of ingrown toenails. Dermatol Surg. 2014;40(10):1132–9.
11. Richardson EG, Hendrix CL. Campbell’s Operative Orthopaedics. 2003: 4171–4187.
12. Zuber TJ. Ingrown toenail removal. Am Fam Physician. 2002:15;65(12):2547–52, 2554.
13. Gerritsma-Bleeker CLE, Klaase JM, Geelkerken RH, Hermans J, van Det RJ. Partial matrix excision or segmental phenolization for ingrowing toenails. Arch Surg. 2002;137(3):320–5.
14. Kuwada GT. Long-term evaluation of partial and total surgical and phenol matrixectomies. J Am Podiatr Med Assoc. 1991;81(1):33–6.
15. Grieg JD, Anderson JH, Ireland AJ, Anderson JR. The surgical treatment of ingrowing toenails. J Bone Joint Surg Br. 1991;73(1):131–3.
16. Bostanci S, Kocyigit P, Gürgey E. Comparison of phenol and sodium hydroxide chemical matricectomies for the treatment of ingrowing toenails. Dermatol Surg. 2007;33(6):680–5.
17. Murray WR, Bedi BS. The surgical management of ingrowing toenail. Br J Surg. 1975;62(5):409–12.
18. Vinay K, Narayan Ravivarma V, Thakur V, et al. Efficacy and safety of phenol-based partial matricectomy in treatment of onychocryptosis: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2022;36(4):526–35.
19. Yılmaz A, Çenesizoğlu E. Partial matricectomy with cryotherapy in treatment of ingrown toenails. Acta Orthop Traumatol Turc. 2016;50(3):262–8.
20. Kim M, Song IG, Kim HJ. Partial Removal of Nail Matrix in the Treatment of Ingrown Nails: Prospective Randomized Control Study Between Curettage and Electrocauterization. Int J Low Extrem Wounds. 2015;14(2):192–5.
21. DeBrule MB. Operative treatment of ingrown toenail by nail fold resection without matricectomy. J Am Podiatr Med Assoc. 2015;105(4):295–301.
22. 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.
23. Misiak P, Terlecki A, Rzepkowska-Misiak B, Wcisło S, Brocki M. Comparison of effectiveness of electrocautery and phenol application in partial matricectomy after partial nail extraction in the treatment of ingrown nails. Pol Przegl Chir. 2014;86(2):89–93.
24. Aksakal AB, Atahan C, Oztaş P, Oruk S. Minimizing postoperative drainage with 20% ferric chloride after chemical matricectomy with phenol. Dermatol Surg. 2001;27(2):158–60.
25. Derriks JHG, Hilgersom NFJ, Middelkoop E, Samuelsson K, van den Bekerom MPJ. Electrocautery in arthroscopic surgery: intra-articular fluid temperatures above 43 °C cause potential tissue damage. Knee Surg Sports Traumatol Arthrosc. 2020;28(7):2270–8.
26. Turan Ç, Şahin T, Meral Ekşioğlu H. How effective is cryotherapy applied to the nail fold in ingrown toenails? Acta Dermatovenerol Alp Pannonica Adriat. 2020;29(1):11–9.