Effective and enduring surgical treatment for targeted therapy-related paronychia: A retrospective study.

The development of targeted therapy has improved treatment outcomes for patients with non-small cell lung cancer (NSCLC). However, paronychia, a common adverse effect of targeted therapy, remains burdensome. Although conservative treatments for paronychia have been well reported in the literature, studies on the efficacy of surgical partial matricectomy for paronychia, are scarce. This study aimed to evaluate the effect of surgical partial matricectomy in targeted therapy-induced paronychia in patients with NSCLC. This retrospective cohort study included 11 patients with a total of 18 lesions on the big toes. Data on lung cancer stages, types and duration of targeted therapy, onset of paronychia, pain scale scores, conservative treatments, course of matricectomy, paronychia-free interval after matricectomy, and wound condition were collected from medical records. The Wilcoxon signed-rank test was used for analysis. The mean pain scale score after matricectomy was significantly lower than that after conservative treatments (1.00 ± 0.00 vs 2.94 ± 0.87; P < .001) and before treatment (1.00 ± 0.00 vs 3.06 ± 0.80; P < .001). The mean duration of matricectomy was significantly shorter than that of conservative treatments (3.22 ± 1.00 vs 56.56 ± 52.29 weeks; P < .001). Surgical partial matricectomy is an effective and enduring intervention for targeted therapy-related paronychia. It provides a shorter course of treatment, reduced pain, and improved appearance of the healed wound. Furthermore, surgical partial matricectomy could result in a better quality of life during targeted therapy than that of conservative treatments.

[Paronychia and Felons - Surgical Treatment]. / Infektionen am Fingerendglied.

Infections of the distal phalanx are the most common of all hand infections. There are dorsal localised infections, which develop in the area of the nail and are called paronychia, and palmar infections, which affect the fingertip and are the typical felons. The acute paronychia must be specifically opened depending on the site of infection. This requires precise anatomical knowledge of nail structure. Chronic paronychia usually have other causes and treatment is much more difficult. Felons are often extremely painful. There is a complex system of fibrous septa and swelling is limited. If the septa are destroyed a spread into the bones or the flexor tendon sheath is possible.

Surgical Intervention for Paronychia Induced by Targeted Anticancer Therapies.

BACKGROUND: Paronychia is a common toxicity associated with targeted anticancer therapies. Antibiotics and steroids are the standard treatments for severe paronychia, yet they are often inadequate, prolonging the patient's suffering and resulting in changes to effective cancer therapy. OBJECTIVE: This article describes the clinical course of drug-induced paronychia and attempts to identify circumstances under which nail surgery may be beneficial. MATERIALS AND METHODS: This is a retrospective case series from a single institution's electronic medical record for patients on paronychia-inducing anticancer therapies with nail disease visit diagnosis codes. RESULTS: The authors identified 36 nail procedures performed on 12 patients, all of whom were managed with conservative steroid and antibiotic therapy with varying degrees of improvement; however, no further improvement was seen after 90 days. Partial matricectomy, nail avulsion, debridement/clipping, and incision and drainage were performed with resolution rates of 100% (11/11), 38.5% (5/13), 12.5% (1/8), and 0% (0/4), respectively. The average time to surgical intervention was 196 days, and the average time to resolution was 268 days. CONCLUSION: This series highlights the prolonged course of severe drug-induced paronychia and the importance of surgical intervention to reduce pain and impact on cancer treatment. Partial matricectomy should be considered for paronychia unresponsive to conservative therapy by 3 months.

Management of Paronychia in Patients With Apert Syndrome.

Apert syndrome is a complex congenital syndrome that includes bicoronal craniosynostosis, craniofacial dysmorphologies, cleft palate, hearing loss, spina bifida occulta, cardiac anomalies, and affects the upper and lower extremities-producing complex syndactyly in these patients. Management of the hands yields several challenges and mandates close follow-up to balance repair of complex polysyndactyly with other pressing interventions, such as posterior cranial vault distraction and surgical management of the airway. Our goals of therapy for the hands are to preserve 10 digits, provide sufficient soft tissue coverage, optimize hand function, and minimize the number of surgical interventions. Ideally, surgical management of the hand differences occurs between the ages of 9 months and 2 years, to optimize neurocognitive development. In complex syndactyly observed in patients with Apert syndrome, there are broad, conjoined nail plates that overlie the fused digits, and paronychia occurs frequently. Suppurative infections can delay definitive surgical intervention for the patient's complex syndactyly, and resolution of paronychia is critical. This study aims to propose an effective and safe technique to manage paronychia when it occurs in patients with Apert complex syndactyly and to mitigate the length of delay to definitive polysyndactyly reconstruction. In the context of these patients' need for multiple surgical interventions within the first few years of life, this strategy for preventing or mitigating paronychia can play an important role in streamlining their complex surgical management while avoiding multiple cancellations.

Purulent Pericarditis Due to Paronychia in a 16-Month-Old Child: A Nail-Biting Story.

Purulent pericarditis is a rare infectious disease with significant mortality, even in the modern antibiotic era. The presenting signs can often be subtle and patients can deteriorate rapidly with cardiac tamponade. We report a previously healthy 16-month-old female who developed purulent pericarditis associated with paronychia and sepsis caused by methicillin-sensitive Staphylococcus aureus. In addition to antibiotic treatment, she required emergent pericardiocentesis for cardiac tamponade, followed by two surgical interventions including full median sternotomy incision and partial pericardiectomy. At 4-month follow-up, she did well with no evidence of constrictive pericarditis on echocardiogram.

Toe keloid after nail extraction treated with surgical excision: A case report.

RATIONALE: In this study, a case of toe keloid after nail extraction is presented, in which the keloids on both toes were resected by surgical excision. Keloids (from the Greek word meaning "crab's claw") are fibrous growths that extend beyond the original area of injury to involve the adjacent normal skin. In general, keloid tendencies appear to be regionally isolated to keloid-prone areas, such as the chest, ears, and deltoid regions, whereas the hands and feet are usually spared, which is why this case is meaningful. PATIENT CONCERNS: A 20-year-old Chinese man had paronychia on both halluxes when he was 16 years old. He underwent a nail extraction at the age of 17. The nails of both halluxes were removed by nail extraction. This operation was successful, and the postoperative course was uneventful. After 6 months, the scars of the nail extraction on both sides began to exhibit hyperplasia and became red and swollen with itching. Later, the scar expanded and eroded the tissue beyond the matrix unguis. The whole matrix unguis was destroyed, and the nails were distorted. The scars began to ulcerate after 2 years. The patient used potassium permanganate to clean his wounds, but the keloid scars did not improve. DIAGNOSES: The patient was diagnosed as toe keloid based on his history and symptoms. The biopsy result supported our diagnoses. INTERVENTIONS: The toe keloids were effectively cured by surgical excision and skin flap transplantation combined with postoperative irradiation and hyperbaric oxygen (HBO) treatment. OUTCOMES: No recurrence was detected during the period from 6 to 24 months of follow-up after the surgery. LESSONS: In this case, the trauma of the nail extraction was likely the key cause of the keloid. However, the patient was also predisposed to keloids, as we observed keloids on his chest. In general, keloid tendencies appear to be regionally isolated to keloid-prone areas such as the chest, ears, and deltoid regions, whereas the hands and feet are usually spared, which is why this case is meaningful.

[Surgical treatment of ingrown toenail and paronychia with lateral toe incision].

Objective: To investigate and compare the advantages of surgical treatment of ingrown toenail with the traditional Winograd method. Methods: From Aug.2013 to Jun.2015,77 cases (89 toes) with 15-58 years were involved in the study.37 cases (42 toes) were treated with Winograd method and other 40 cases (47 toes) were treated with a method using lateral incision without cutting the nail fold. The time of returning to normal activities, infection rate, recurrence rate, pain VAS score and shape satisfaction VAS score were evaluated to display the aesthetic and functional result of the both methods. Results: All patients were followed up with an average of 8.6 months. The patients treated with the novel method returned to normal activities after (5.3 ± 0.5) d post-surgery, which was much shorter than that (7.3 ± 0.6) d in patients with the Winograd method (P ＜ 0.05).And the infection rate in the lateral incision group was also lower than that in the Winograd method group (P ＜ 0.05).At 3 days post-surgery, the pain VAS score in Winograd method group was higher (P ＜ 0.05),but the difference of pain VAS score disappeared after 1 and 6 months post-surgery (P ＞ 0.05).The shape satisfaction VAS score were 9.2 ± 0.6 in the lateral incision group and 7.1 ± 0.7 in the Winograd group, showing significant difference (P ＜ 0.05). Conclusions: The lateral incision method without incising the nail fold reserves the nail groove and brings faster recovery to normal activities with less pain, lower infection rate and more satisfactory toenail shape.

Acute felon and paronychia: Antibiotics not necessary after surgical treatment. Prospective study of 46 patients.

Paronychia and felon are the most common infections of the hand. Surgical treatment is required once an abscess develops, but systematic use of postoperative antibiotic therapy remains open for discussion. Antibiotics both favor the selection of resistant bacteria and increase the cost of treatment. To our knowledge, no study has demonstrated their benefit following excision, yet many practitioners prescribe them systematically and empirically. In our current practices, we do not use antibiotic coverage following excision of uncomplicated paronychia or felon (no signs of arthritis, osteitis, flexor tenosynovitis, lymphangitis), except in potentially at-risk patients (immunosuppressed, diabetic, cardiac valve prosthesis recipient). Since this approach seems to lead to good outcomes, our objective was to evaluate them clinically in this study. Our prospective study included 46 patients who were not considered at risk. There were 26 cases of paronychia, 3 cases of felon and 17 patients presenting both paronychia and felon. All cases were abscessed and uncomplicated. All patients underwent surgical excision, and none received postoperative antibiotics. Follow-up took place on the day after surgery, at days 7, 14, 21 and 45. The main criterion for evaluation was healing of the infection and the wound. We recorded 45 cases of healing with no complications and a single case of recurrence. Surgical excision of paronychia or felon without antibiotic coverage gives excellent results with only rare recurrence. The single failure can be attributed to inadequate excision. Antibiotic therapy has no role in managing uncomplicated felon or paronychia in patients who are otherwise not at risk. Successful treatment depends above all on the completeness of the surgical excision.

Chronic paronychia treatment: Square flap technique.

BACKGROUND: Chronic paronychia is an inflammatory process of the periungual folds that lasts longer than 6 weeks. It manifests as hypertrophy of the proximal and lateral nailfolds, absence of cuticle, progressive retraction of the proximal nailfold, and onychodystrophy. Surgical treatment is recommended if there has been insufficient response to 6 months of appropriate medical therapies. OBJECTIVE: We describe a new surgical technique that removes the fibrotic tissue without complete excision of the proximal and lateral nailfold, minimizing nailfold retraction and recovery time. METHODS: We present a case series of 34 fingers (9 patients) treated with this new technique. RESULTS: All nailfolds healed well without complications. At the end of the follow-up, all fingers, apart from 2, were relieved of the preoperative symptoms. The length of the ungual plate was maintained in all patients, with no retraction of the nailfolds. LIMITATIONS: Follow-up period of 6 months and small sample size are limitations of this study. CONCLUSION: This surgical technique can provide an alternative treatment for chronic paronychia, with good prognosis during follow up-period and optimal cosmetic results.

Paronychia-like cutaneous leishmaniasis.

Chronic paronychia is an inflammatory recalcitrant disorder affecting the nail folds. We report one patient with paronychia revealing ungueal leishmaniasis. A 34-year-old man, resident in the north of Morocco, presented with a 6-month history of an inflamed proximal nail fold of the left thumb, resistant to antibiotics and anti-fungal treatments. En bloc excision of the proximal nail fold was done. The histopathological exam showed epithelioid granulomas with giant cells and the presence of leshmania amastigotes, leading to the diagnosis of ungueal leishmaniasis. Clinical aspects of cutaneous leishmaniasis can be very misleading. The paronychial form is rarely described. In endemic areas it is necessary for the physician to be aware of atypical skin presentations of leishmaniasis.

Digital gangrene in a patient with primary Raynaud's phenomenon.

Digital gangrene is not usually associated with primary Raynaud's phenomenon (RP). Its presence should therefore alert the healthcare provider to look for an alternative explanation. A 19-year-old female patient with primary RP developed digital gangrene following surgical management of acute paronychia. The possible mechanism in this patient appears to be the augmentation of the vasoconstrictive response due to the local infiltration of epinephrine mixed with lignocaine prior to the incision and drainage of her infected finger.

[Treatment of paronychia]. / Die Nageltascheninfektionen der Finger - Behandlung der Paronychien.

OBJECTIVE: The procedure is selected based on the stage of infection with careful removal of the focal infection in the area of the nail fold. INDICATIONS: All infections of the periungual area. CONTRAINDICATIONS: Herpes infections [1, 12]. All purulent infections of the periungual area should be eliminated. SURGICAL TECHNIQUE: Opening of the abscess, excision of the eponychium, mobilization of the nail barrier away from the nail plate, inzision of the nail barrier at a defined place, necrosectomy, irrigation, and drainage. POSTOPERATIVE MANAGEMENT: Moist dressings and fingerbaths in the first few days. RESULTS: In most cases, the infection heals completely without substantial scar formation.

Swiss roll technique for treatment of paronychia.

Management of paronychia should primarily be aimed at preventing any activity that results in impairment of the natural barrier function of the nail fold. Surgical treatments aim to cure paronychia by exposing the inflamed germinal matrix to permit unrestricted drainage. We describe a Swiss roll technique for treatment of chronic and severe acute paronychia.

[Ingrown nail: A new cause of chronic perionyxis]. / Une nouvelle cause de périonyxis chronique : la rétronychie.

BACKGROUND: Retronychia is the phenomenon of ingrown nail resulting in inflammation of the proximal subungual fold and is a newly described entity. Herein, we report a new case revealed through chronic proximal perionyxis. PATIENTS AND METHODS: A 52-year-old woman followed up for hypothyroidism, for which she was receiving treatment, consulted for pain in the lateral fold of the left big toe that had been ongoing for four months and for which glomic tumour was the suspected cause. Questioning revealed repeated microtrauma due to wearing of tight shoes and lack of growth of the toenail over the previous four months (in contrast with the contralateral toenail). Examination showed painful proximal perionyxis of the left big toe, with discharge from the subungual fold. Ultrasound examination of the subungual fold revealed effusion of fluid around the matrix, and this was confirmed by MRI. Surgical avulsion of the nail was carried out, and recovery was complete. DISCUSSION: Retronychia is the result of a loss of continuity between the nail plate and the nail matrix, generally as a result of mechanical factors (distal trauma). However, unlike onychomadesis or Beau's lines, there is a disturbance of alignment between the two parts of the nail, which is normally maintained by the proximal subungual fold. This prevents newly formed nail from progressing towards the distal part of the plate, which itself is pushed into the nail bed and forced towards the proximal fold, causing inflammation of the latter structure. In our case, the pain recorded in the lateral fold was misleading, hence the ultimately unnecessary use of MRI to rule out the hypothesis of glomic tumour. Paronychia, discontinuation of nail growth and weeping through the subungual fold all argued in favour of a diagnosis of retronychia, which was confirmed by surgery. Surgical nail removal is the curative treatment for retronychia and results in complete cure without relapse or occurrence. CONCLUSION: Retronychia should be suspected in the event of persistent proximal perionyxis, particularly in a setting of trauma with interrupted nail growth. Nail avulsion constitutes both a diagnostic and a therapeutic procedure.

[Surgical managing of current cutaneous infections in children]. / Prise en charge chirurgicale des infections cutanées communes de l'enfant.

The cutaneous infectious pathology of the child is varied and frequent. Authors deal with surgical infections seen in current pediatrics, which often have to appeal to a plastic pediatric surgeon for their treatment. Superficial infections of skin and pilo-sebaceous follicles are common in big children. The folliculitis and the boil are the most frequent. Their treatment is medical and surgical and does not require an antibiotic treatment in most of the cases. The primitive abscesses or following an anterior lesion recover from a similar treatment. Some localizations or risky context need a particular follow-up. The whitlow is a particular example and needs to have a particular follow-up because of the risk of hand cellulitis. Nails embodied of the child require a specialized notice because of their numerous clinical forms, which must be distinguished according to the age. Finally the necrotizing cellulitis and fasciitis are surgical emergencies and have a well-codified treatment. These infections in children must benefit from an attentive care because when they are badly treated, they can involve the aesthetic, functional and vital forecast.

Acute and chronic paronychia.

Paronychia is an inflammation of the folds of tissue surrounding the nail of a toe or finger. Paronychia may be classified as either acute or chronic. The main factor associated with the development of acute paronychia is direct or indirect trauma to the cuticle or nail fold. This enables pathogens to inoculate the nail, resulting in infection. Treatment options for acute paronychia include warm compresses; topical antibiotics, with or without corticosteroids; oral antibiotics; or surgical incision and drainage for more severe cases. Chronic paronychia is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens. The patient should avoid exposure to contact irritants; treatment of underlying inflammation and infection is recommended, using a combination of a broad-spectrum topical antifungal agent and a corticosteroid. Application of emollient lotions may be beneficial. Topical steroid creams are more effective than systemic antifungals in the treatment of chronic paronychia. In recalcitrant chronic paronychia, en bloc excision of the proximal nail fold is an option. Alternatively, an eponychial marsupialization, with or without nail removal, may be performed.

[Chancre of the finger. A circuitous route to diagnosis]. / Primäraffekt am Finger unter dem Bild einer chronischen Paronychie. Umwege zur Diagnose.

A 33-year-old woman presented with a 4-months history of a granulating ulcer on the right index finger. Paronychia was suspected and nail extraction with subsequent histopathologic examination of the removed tissue was performed. Two months later, it became known that the patient's sexual partner had been treated for syphilis. The patient's serology was also positive. Subsequent examination of the original tissue sample by polymerase chain reaction, immunohistochemistry using Treponema pallidum-specific antibodies, and silver staining revealed large numbers of syphilis bacteria, confirming the diagnosis of extragenital chancre.