Correction of pincer-nail deformities with autograft or homograft dermis: modified surgical technique.

The pincer-nail deformity is characterized by an excessively curved and distorted nail across the transverse dimension. Forty-nine sides (paronychial folds) were dissected off the distal phalanx periosteum with scissors and/or a small elevator. The dermis was placed between the paronychial fold and the plalanx to flatten the germinal and sterile matrix. Direct comparison of autograft dermis to homograft dermis did not show any significant differences in postcorrection appearance of the nail or relief of symptoms. Surgical time averaged 22 minutes less in those patients having reconstruction on both sides of one nail with homograft dermis.

Onychauxic dystrophic toenails requiring debridement in Medicare patients. Prevalence and anatomical distribution.

Six hundred twenty-nine Medicare patients were evaluated for the presence of onychauxic toenails that in the judgment of the examiners required reduction. Forty-two percent of this group had five or fewer toenails requiring reduction and 24.3% had six or more toenails requiring reduction. Statistics reported by a regional Medicare-contracted carrier for the years 1997 to 1999 showed that 95% of claims submitted for nail debridement were for six or more nails and 5% were for five or fewer nails. The 1999 Medicare Part B data listed the top 300 Current Procedural Terminology (CPT) foot-care codes in order of utilization. Code 11721 (debridement of six or more nails) was number one. National statistics from the Health Care Financing Administration in 1999 indicated approximately a 5:1 ratio in favor of CPT code 11721 (six or more nails). In contrast, this study found a ratio of 2:1 in favor of CPT code 11720 (five or fewer nails).