Comparison of 2 Anesthetic Techniques in Onychocryptosis Surgery of the Great Toe: A Randomized Clinical Trial. / Comparación de 2 técnicas de bloqueo anestésico en el tratamiento quirúrgico de onicocriptosis del primer dedo del pie.

BACKGROUND AND OBJECTIVE: Surgery for an ingrown toenail of the great toe is a common procedure that requires an anesthetic neuromuscular blockade of the entire digit. Various digital block techniques have been described, but no evidence-based recommendations on the best choice have emerged. We aimed to compare the V block to the H block in this type of surgery. MATERIAL AND METHODS: Multicenter randomized clinical trial in patients undergoing onychocryptosis surgery between February 2018 and February 2020. We recorded sex, age, foot intervened, type of blockade used (H block or V block), efficacy 10 and 20minutes after injection of the anesthetic, and number of attempts. RESULTS: A total of 140 surgeries to treat ingrown toenails were assigned to 2 groups (H block or V block) of 70 patients each. The same anesthetic, dose, and volume were used in all cases. The V technique produced a better neuromuscular block in 7.2% more cases at 10minutes and in 12.8% more at 20minutes. CONCLUSIONS: Both block techniques are safe and effective. The V block is a good alternative to the H block in patients undergoing surgery to treat an ingrown toenail.

Comparación de 2 técnicas de bloqueo anestésico en el tratamiento quirúrgico de onicocriptosis del primer dedo del pie / Comparison of 2 Anesthetic Techniques in Onychocryptosis Surgery of the Great Toe: A Randomized Clinical Trial

Introducción: La cirugía en onicocriptosis del primer dedo del pie es un procedimiento común que requiere de un bloqueo anestésico completo del dedo. Existen diferentes técnicas, pero no hay recomendaciones basadas en la evidencia sobre el mejor tipo de técnica de anestesia. En este contexto, nuestro objetivo fue evaluar si el bloqueo anestésico en V presenta ventajas respecto al bloqueo en H. Material y métodos: Se realizó un estudio observacional, prospectivo y multicéntrico en pacientes sometidos a cirugía de onicocriptosis entre febrero de 2018 y febrero de 2020. Se distribuyó a los pacientes aleatoriamente en 2 grupos. Se recogieron los siguientes datos: sexo, edad, tipo de bloqueo según técnica (técnica H o técnica V), eficacia de la técnica a los 10 y 20min posteriores a la infiltración, pie afectado y número de refuerzos anestésicos. Resultados: Se incluyeron 140 intervenciones quirúrgicas sobre uñas con onicocriptosis, que se dividieron en 2 grupos. Se compararon las variables después de realizar los distintos abordajes anestésicos con el mismo agente anestésico, dosis y volumen. A 70 intervenciones se les asignó la técnica H y a otras 70 intervenciones se les asignó la técnica V. Al analizar los tiempos de eficacia, se observó que la técnica V fue mejor en un 7,2% a los 10min y en un 12,8% a los 20min frente a la técnica H. Conclusiones: Los 2 métodos de bloqueo anestésico son seguros y eficaces. La técnica V es una buena alternativa a la técnica H en pacientes sometidos a cirugía de onicocriptosis (AU)

Background and objective: Surgery for an ingrown toenail of the great toe is a common procedure that requires an anesthetic neuromuscular blockade of the entire digit. Various digital block techniques have been described, but no evidence-based recommendations on the best choice have emerged. We aimed to compare the V block to the H block in this type of surgery. Material and methods: Multicenter randomized clinical trial in patients undergoing onychocryptosis surgery between February 2018 and February 2020. We recorded sex, age, foot intervened, type of blockade used (H block or V block), efficacy 10 and 20minutes after injection of the anesthetic, and number of attempts. Results: A total of 140 surgeries to treat ingrown toenails were assigned to 2 groups (H block or V block) of 70 patients each. The same anesthetic, dose, and volume were used in all cases. The V technique produced a better neuromuscular block in 7.2% more cases at 10minutes and in 12.8% more at 20minutes. Conclusions: Both block techniques are safe and effective. The V block is a good alternative to the H block in patients undergoing surgery to treat an ingrown toenail (AU)

[Translated article] Comparison of 2 Anesthetic Techniques in Onychocryptosis Surgery of the Great Toe: A Randomized Clinical Trial / Comparación de 2 técnicas de bloqueo anestésico en el tratamiento quirúrgico de onicocriptosis del primer dedo del pie

Background and objective: Surgery for an ingrown toenail of the great toe is a common procedure that requires an anesthetic neuromuscular blockade of the entire digit. Various digital block techniques have been described, but no evidence-based recommendations on the best choice have emerged. We aimed to compare the V block to the H block in this type of surgery. Material and methods: Multicenter randomized clinical trial in patients undergoing onychocryptosis surgery between February 2018 and February 2020. We recorded sex, age, foot intervened, type of blockade used (H block or V block), efficacy 10 and 20minutes after injection of the anesthetic, and number of attempts. Results: A total of 140 surgeries to treat ingrown toenails were assigned to 2 groups (H block or V block) of 70 patients each. The same anesthetic, dose, and volume were used in all cases. The V technique produced a better neuromuscular block in 7.2% more cases at 10minutes and in 12.8% more at 20minutes. Conclusions: Both block techniques are safe and effective. The V block is a good alternative to the H block in patients undergoing surgery to treat an ingrown toenail (AU)

Introducción: La cirugía en onicocriptosis del primer dedo del pie es un procedimiento común que requiere de un bloqueo anestésico completo del dedo. Existen diferentes técnicas, pero no hay recomendaciones basadas en la evidencia sobre el mejor tipo de técnica de anestesia. En este contexto, nuestro objetivo fue evaluar si el bloqueo anestésico en V presenta ventajas respecto al bloqueo en H. Material y métodos: Se realizó un estudio observacional, prospectivo y multicéntrico en pacientes sometidos a cirugía de onicocriptosis entre febrero de 2018 y febrero de 2020. Se distribuyó a los pacientes aleatoriamente en 2 grupos. Se recogieron los siguientes datos: sexo, edad, tipo de bloqueo según técnica (técnica H o técnica V), eficacia de la técnica a los 10 y 20min posteriores a la infiltración, pie afectado y número de refuerzos anestésicos. Resultados: Se incluyeron 140 intervenciones quirúrgicas sobre uñas con onicocriptosis, que se dividieron en 2 grupos. Se compararon las variables después de realizar los distintos abordajes anestésicos con el mismo agente anestésico, dosis y volumen. A 70 intervenciones se les asignó la técnica H y a otras 70 intervenciones se les asignó la técnica V. Al analizar los tiempos de eficacia, se observó que la técnica V fue mejor en un 7,2% a los 10min y en un 12,8% a los 20min frente a la técnica H. Conclusiones: Los 2 métodos de bloqueo anestésico son seguros y eficaces. La técnica V es una buena alternativa a la técnica H en pacientes sometidos a cirugía de onicocriptosis (AU)

Onicocriptosis congénita: a propósito de un caso / Congenital onychocryptosis: about a case

La onicocriptosis o una encarnada (unguis incarnattus) es una enfermedad ungueal , causada por la penetración de los bordes laterales y el extremo distal de la lámina ungueal al perioniquio. La onicocriptosis congénita o de la primera infancia es una forma de presentación muy poco frecuente y se cree debida a un trauma intrauterino o a transmisión hereditaria. Su tratamiento depende del estudio en que se encuentre la omicocriptosis. Presentamos el caso clinico de una infante de 20 meses de edad con onicoriptosis en el primer dedo de ambos pies, en estadio III.

Super U Technique for Ingrown Nails. / Exéresis en U para la onicocriptosis.

INTRODUCTION AND OBJECTIVES: Ingrown nails are a common problem, seen mostly in young adults. Also known as onychcrypotisis, this condition typically affects the great toenail. Four stages have been defined according to the severity and duration of the condition, and treatment varies from conservative to surgical techniques depending on the stage. We present our experience with this condition, describing the characteristics of our population and surgical treatment, in particular the super U technique. MATERIAL AND METHODS: This was a retrospective, descriptive study of patients with ingrown great toenail treated surgically using the super U technique. We also describe postoperative management. RESULTS: Ten patients with a mean age of 35.7 years underwent operation, 9 for unilateral ingrown great toenail and 1 for bilateral disease. Stage II ingrown nail was the most common. Half of the patients had been treated previously using other surgical techniques. The mean time to healing was 6 weeks. The only postoperative complication was infection in 1 patient. Mild to moderate postoperative pain persisted for a week. The majority of patients were satisfied with the cosmetic result. CONCLUSIONS: We believe the super U technique is very useful in stage II ingrown nail and in disease that has recurred after previous surgery, and is the treatment of choice in stage III or IV disease in which excessive hypertrophic tissue is found.

[Management of onychocryptosis in primary care: A clinical case]. / Manejo de la onicocriptosis en atención primaria. Caso clínico.

Onychocryptosis (ingrown toenail) is a condition commonly seen in Primary Care clinics. It is uncomfortable and restrictive for patients and has a high incidence in males between second and third decades of life. It is of unknown origin, with a number of predisposing triggering factors being involved. Treatment depends on the stage of the ingrown nail and the procedures may range from conservative to minor surgery that can be performed by the Primary Care physician in the health centre. We report the case of a 25-year onychocryptosis that did not respond to conservative management, and was extracted with partial matricectomy of the nail.

Uso de antibióticos en cirugía dermatológica: revisión / Use of antibiotics in dermatologic surgery: review

El uso de antibióticos tópicos y orales debe asumirse con cautela. Los antibióticos orales deben ser prescritos considerando herida de alto riesgo, y paciente de alto riesgo. Las heridas de alto riesgo son las que se realizan en sitios infectados, alteraciones músculoesqueléticas, y mucosa oral. Los pacientes de alto riesgo incluyen los susceptibles a desarrollar endocarditis bacteriana, y los que han recibido recambio protésico de algún tipo, bajo procedimientos dermatológicos de alto riesgo. Ciertas áreas del cuerpo ­no obstante- como la rodilla, axila e ingle, y cirugías reconstructivas como resecciones en labios y nariz, están asociadas a una mayor tasa de infección, y podrían requerir antibióticos profilácticos. Existen amplias controversias en el uso de antibióticos, como su asociación a enfermedades respiratorias en uso a largo plazo, o mayor probabilidad de reacciones alérgicas. Quizá la onicocriptosis es la más controversial de las indicaciones antibióticas, en donde varios estudios se pronuncian a favor y en contra

Topical and oral antibiotics should be used with caution. Antibiotics must be indicated in high risk wounds, and high risk patients. High ­ risk wounds include involvement of oral mucosa and surgery performed on clinically infected skin, or musculoskeletal tissue. High ­ risk patients include those susceptible to develop bacterial endocarditis, and those who have received any prosthetic joint, undergoing high ­ risk dermatologic procedures. Nevertheless, some sites of the body, such as knee, armpit and groin, and reconstructive surgery as skin flaps in nose and lips, are associated with a high infection rate, and would need antibiotic prophylaxis. There are a lot of controversies with the use of antibiotics, because they can produce upper respiratory tract infections in the long ­ term use, or high risk of allergy. Perhaps, onychocryptosis is the most controversial matter, with several researchs pro and against the use of antibiotics