Influence of smoking on wound healing in patients undergoing nail matrix phenolization: a prospective randomized clinical study.

PURPOSE: To enhance the learner's competence with knowledge of the effect of smoking on wound healing in patients undergoing nail matrix phenolization. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to:1. Summarize factors that affect wound cicatrization and pathophysiologic mechanisms of impaired healing from smoking as found in prior studies from review of the literature.2. Analyze components and findings of this research study on how healing from phenol ablation is influenced by smoking. ABSTRACT OBJECTIVE: Healing time can be delayed by extrinsic factors such as smoking. No controlled study has analyzed the influence of smoking on wound healing in patients undergoing nail matrix phenolization. The main objective of this work was to analyze wound healing burns after segmental phenolization in smoker versus nonsmoker patients; the secondary aim was to examine the influence of curettage in both groups. DESIGN: In a prospective clinical study, 90 podiatric patients (53 smokers and 37 nonsmokers) with onychocryptosis were randomized to 1 of 2 treatment arms: phenolization with curettage and phenolization alone. The primary outcome was to analyze the healing time (in days) after the segmental phenolization in both groups. Healing was monitored for spontaneous wound closure by clinical assessments and by digital photographs. MAIN RESULTS: The healing time in the curettage group was (8.80 ± 1.51 days in smokers vs 6.72 ± 1.26 days in nonsmokers; P < .0001) and (13.24 ± 1.8 days in the smoker group vs 10.67 ± 1.78 days in the nonsmoker group; P < .0001) in the phenolization alone group. Significant differences were found in respect to time to healing among smokers in both groups (13.24 ± 1.8 days in the phenolization group vs 8.80 ± 1.51 days in the curettage group; P < .0001). Similarly, significant differences were found with respect to time to healing among nonsmokers in both groups (10.46 ± 2.04 days in the phenolization group vs 6.71 ± 1.11 days in the curettage group; P = .0001). CONCLUSION: Burn wounds of smokers take longer to heal than those of nonsmokers. Curettage of the cauterized tissue reduces healing time and should be systematically considered.

Effect of curettage after segmental phenolization in the treatment of onychocryptosis: a randomized double-blind clinical trial.

BACKGROUND: Segmental phenolization for the treatment of onychocryptosis has a number of disadvantages, resulting from the cauterization of the tissue, including delayed healing and prolonged drainage. Although one may expect excision or curettage of the cauterized tissue after phenolization to benefit the healing process, these simple procedures have not been suitably studied. OBJECTIVE: To examine the effect of curettage primarily on cicatrization or healing time and secondarily on postoperative bleeding. MATERIALS AND METHODS: Fifty-one patients (80 feet) with stage I or IIa onychocryptosis according to the classification of Mozena were enrolled in this randomized, double-blind, parallel-group, controlled clinical trial. A total of 137 phenolizations were performed on affected folds of ingrowing hallux nails. Each hallux was randomly assigned to one of two groups (experimental [phenolization with curettage]; control [phenolization alone]). RESULTS: Curettage reduced healing time (7.49 ± 1.76 days vs 12.38 ± 3.01 days; p = .001), increased postoperative bleeding (p < .001), led to lower rates of infection (p = .01), and increased postoperative pain (p = .028). CONCLUSION: Curettage of the cauterized tissue after segmental phenolization reduces healing time.