Long-term results of nail correction with double wires for pincer nail deformity: A retrospective cohort study.

There is no consensus on the best treatment for pincer nail deformity. We developed a novel procedure that uses double wires to treat pincer nail deformity on the great toe. This study aimed to describe this technique for pincer nail deformity treatment and present the long-term findings/observations. After injecting a local anesthetic, a mini router was used to make holes on both sides of the nail plate edge, and the wire was inserted in two places, one proximal and the other distal to the great toenail. The wire was removed when it moved to the tip of the great toe as the nail grew. Patients who underwent this method were evaluated retrospectively from 2014 to 2020. Patients with less than 24 months of follow-up were excluded. If pain occurred again, it was deemed as a recurrence. A total of 27 patients (36 toes, mean age: 69.5 years) were evaluated. In all cases, the pain disappeared 1 week after the procedure. In the correction period (mean 2.7 months), six toes had complications (nail break, four toes and nail hold pain, two toes), while recurrence occurred in four toes within 2 years. Curvature (nail tip height/width of nail tip × 100%) improved significantly up to 1-year post-procedure (37.7 ± 14.4%, p < 0.05) as compared to pre-correction (53.8 ± 24.7%). The procedure time was short (approximately 10 minutes), and the treatment was completed with a single procedure. In addition, the recurrence rate was low.

Congenital curved nail of the fourth toe: Report of three cases and review of the literature.

Congenital curved nail of the fourth toe (CNFT) is a rare disorder in which the nail plate of the fourth toe is deformed as it curves toward the sole of the foot. The cause is still unknown, but the congenital deformity of the nail plate is thought to be due to shortening of the terminal phalanx and hypoplasia of soft tissue of the fourth toe. Here, we report three typical cases who presented congenital curving nail on both their fourth toes. Their X-ray showed that the distal phalanges of the fourth toes were short. Thus far, 19 cases of CNFT were reported in English literature. Interestingly, almost all cases have been from Asia (18 out of 19). The majority of the cases were bilateral and asymptomatic. Tenderness was seen in eight cases, which was caused by the pressure of the nail plate on the skin or ingrown nail. Treatment is basically unnecessary for the deformity, but it is important to teach safe and appropriate nail clipping methods to avoid pain. We can easily diagnose CNFT because of the characteristic clinical presentation and should provide appropriate advice on the nail care from early stage.

Aesthetic correction of short nail deformity in congenital brachydactyly Type D by distraction lengthening.

Brachydactyly Type D is a congenital condition of the thumb in which there is a short and broad thumbnail. Although the thumb function is often unaffected, some patients seek surgery for cosmetic improvement. This study aimed to describe our method of distraction lengthening to correct nail deformity in brachydactyly Type D. A total of 163 thumbs in 95 patients underwent this surgery between 2018 and 2021.The mean thumbnail length improved from 9 mm to 15 mm, with a mean percentage increase of 62%. The ratio of nail length to width changed from 0.6 to 1.1, which was equal to normal. The mean increased fingernail length/width ratio was 0.5, with a percentage change of 78%. No obvious surgical scar was observed. The thumb function was not significantly affected. We conclude that aesthetic correction of short nail deformity in brachydactyly Type D can be achieved by distraction lengthening with high satisfaction and without functional impairment.Level of evidence: IV.

Management of Pincer Nail Deformity by Realignment of Nailbed Using a Dermofascial Graft.

Pincer nail deformity is an uncommon entity which can be painful and cosmetically unappealing. We describe our technique of correcting this deformity by realignment of the nailbed using a dermofascial graft. Pain relief as well as a cosmetically good result have been obtained in all patients, and this has been maintained over the long term. The technique has proven to be safe, effective, and reproducible.

Distal nail embedding treatment using autogenous nails.

A regrowing nail tip after nail avulsion may excessively curve and invaginate into the nail bed. This is treated as a type of ingrown toenail, and is known as distal nail embedding. In most cases, further growth restores the original shape evenly over the nail bed. However, it is often painful and such cases may require treatment. We report a surgical approach that we applied to six cases of distal nail embedding involving pain or deformity of nails caused by a nail tip invaginating into the nail bed and/or cessation of forward nail growth. As our method involves removing a portion of the embedded tip edge nail and inserting the removed nail into the remaining depressed portion, the nail can grow over the bulge. In all six patients in whom we applied this method, the pain and nail deformity resolved and there was no recurrence. We used autogenous nails, which can reduce the pressure imbalance on a nail bed, and this contributed to improving the morphology of nails and nail beds. In addition, the risk of a hypertrophied nail is reduced because half of the nail adheres to the nail bed. Special materials are unnecessary and this method can be conducted with simple outpatient department procedures. There were no cases of a fixed nail section detaching due to a bulge at the nail tip. The inserted nail was maintained in all cases for several months until the nail grew over the bulge.

Onychogryphosis.

BACKGROUND: Onychogryphosis is a nail disorder that can damage nail plates, usually caused by repeated minor trauma to the foot. Onychogryphosis of the toe is commonly seen in clinical practice; however, optimal treatment of the condition is still the subject of debate. The purpose of this study was to evaluate clinical outcomes of patients with toe onychogryphosis treated by subcutaneous flap coverage after total matricectomy. METHODS: In this article, we describe 12 patients who had onychogryphosis on the great toe treated by subcutaneous flap coverage after total matricectomy. There were eight men and four women, with a mean age of 63.8 years (range, 56-74 years). RESULTS: The follow-up period ranged from 4 to 108 months, with an average of 25.2 months. All of the flap reconstructions ultimately survived. CONCLUSIONS: The advantage of the described technique is the avoidance of tight closure of the skin and preservation of toe length. The possible limitation of the technique is poor blood circulation to the feet.

Short-term results of suture treatment for pincer nail deformity.

OBJECTIVES: This study aims to evaluate the cosmetic and functional results of suture treatment on pincer nail deformity (PND). PATIENTS AND METHODS: This study was conducted between June 2018 and November 2018. Sixteen nails of 13 patients (6 males; 7 females; mean age 46.9 years; range, 24 to 74 years) with PND were treated with silk sutures. The pathologic stage (including tissue status and level of pain), visual analog scale (VAS), nail height (H) and width (W) were evaluated pre- and postoperatively. Nail H and W were measured pre- and postoperatively from digital photographs of each nail and H/W ratio was calculated. RESULTS: The postoperative VAS, severity of pain scores, and nail H showed a significant decrease compared to the preoperative values (p<0.05). Curvature of the nail and pain scores decreased in all patients. Nail W showed a significant increase, therefore H/W ratio decreased significantly (p<0.05). Although recurrence of cosmetic deformity was seen at six months, the VAS and tissue scores remained lower than preoperative values. Patients reported favorable outcomes compared to their preoperative complaints. CONCLUSION: The described suture treatment method is an inexpensive, simple technique, not requiring any special material. These results support that this technique is useful for pain relief and tissue healing even if cosmetic recurrence occurs.

An L-shaped flap for the correction of pincer nail deformity: A case report.

Pincer nail deformity is characterised by an excessive transverse curvature of the nail plate that increases along the longitudinal axis of the nail. Although various corrective techniques have been described, there is, no consensus regarding the optimal correction method. We report a novel surgical technique for correcting pincer nail deformity in a 45-year-old male with bilateral omega-shaped pincer nail deformity of the great toes. The nail matrix on the side showing the more severe curvature was removed, and a flattened nail bed was achieved after suturing. An L-shaped skin and subcutaneous tissue flap was also created 5 mm from the junction between the side of the nail with the milder curvature and the distal nail fold. After healing, the pincer nail deformity was successfully eliminated. At the 1-year follow-up, recurrence was not observed and the appearance of toes was satisfactory. This novel surgical technique is simple, minimises damage to the surrounding tissue, avoids injuring the nail bed blood supply and has few postoperative complications.

Collision of Subungual Neurofibroma and Onychomatricoma: S100 Positivity as a Clue.

We present a 41-year-old man with a hemionychodystrophy of the first toe, appearing as a longitudinal thickening of the nail plate, overcurved and with holes in its thickened free margin, thus leading to the clinical diagnosis of onychomatricoma. Complete excision showed typical nail plate of onychomatricoma and, underlying it, curvy disorganized neural-looking fascicles without atypia and with diffuse positivity for S100, interpreted as subungual neurofibroma (NF). Subungual NF is a very rare tumor, with only 12 previous cases reported. Its diagnosis is based on histopathology, as the tumor presents waves or whorls of disorganized neural-looking cells positive for S100. Regarding onychomatricoma, it is characterized by typical glove finger digitations (which were present in our case) and an underlying stroma composed by a cellular superficial layer (this layer expresses CD34 but not CD99) and a more sclerotic and deeper area. As we did not find information on S100 expression in the stroma of onychomatricoma, we have stained 4 typical cases, and all were negative with S100 and positive with CD34, as expected. In conclusion, as "subungual NF" is so rare and, in our case, seems to collide with a typical onychomatricoma, we recommend adding S100 staining to properly characterize tumors involving nail plate, to detect underlying neural tumors, as has happened in our case.

Nail Plate and Bed Reconstruction for Pincer Nail Deformity.

Pincer nail deformity is a severe condition in which the nail bed becomes compressed and the nail shows an overcurvature. We retrospectively analyzed 13 pincer nail deformities treated using our nail plate and bed reconstruction technique. Visual analogue scale scores, the width of nail root, width of nail tip, height of nail tip, width index, and height index were assessed before and after surgery. The overcurvature was corrected after detachment of the nail plate. The nail fold was pushed underneath the nail plate and then fixed. The width of nail tip significantly increased after surgery (p < 0.05) and was maintained during follow-up. The height of nail tip decreased after surgery (p < 0.05). This nail plate and bed reconstruction technique is a simple and quick surgical method for correcting deformities and reduces risks of complications such as skin necrosis and infection compared to other existing surgical techniques. We recommend this efficient surgical technique for the treatment of pincer nails.

An unusually large onychomatricoma.

Onychomatricoma is a rare benign tumour of the nail matrix first described in 1992, and since then, no more than 80 cases have been reported. Despite distinct clinical characteristics, it is frequently misdiagnosed as onychomycosis partly due to remaining an unknown entity. The authors present the case of a patient with a 30-year history of nail abnormalities with more recent growth to alarming dimensions.