Nail Plate And Bed Reconstruction For Pincer Nail Deformity

DISCUSSION

Pincer nail deformity can be congenital or acquired and are associated with shoes, osteoarthritis, and onychomycosis.4) Conservative treatment such as nail bracing is primarily used; however, since it often results in failure or recurrence, most patients require surgical treatment.5) Lee et al.6) reported that 14 of 35 patients (40%) who were treated for pincer nails had a history of failure of previous conservative treatment or recurrence. Since nails have curvatures, Sano and Ogawa7) nonsurgically controlled the balance between mechanical and automatic curvature forces by thinning thickness of the nail using a grinder. Afterwards, the new nail arising from growth was also thinned, and the deformity was corrected by different automatic nail curvature force and upward mechanical force. Another method consists of depression of the lateral nail folds by the dermal flap. Cho et al.8) reported treatment cases using a modified double Z-plasty to remove osteophytes and correct the nail fold. Markeeva et al.9) shortened the nail plates with a 40% urea paste and performed ablation on deformed nail beds and lateral narrowing.

When the overcurvature of a pincer nail becomes severe, it damages the nail bed, significantly reduces the nail width, and increases the height. In our patients, because some portions of the lateral sides of the nails were removed in cases of irregular margins and severe hypertrophy, there was difficulty in determining the increase in the length of the nail root. On the other hand, a large increase in the width of nail tip where deformities had been severe was observed. The nail plates were properly fixed, and thus no significant changes in the length of nail tip were observed during the 6-month follow-up period. The large height of nail tip caused by severe deformities was significantly reduced after the corrective surgery, and the results were maintained until the final follow-up. The width index was improved after correction because the nail root and tip were corrected or polished to match the lengths of each other. Similar indices were maintained during follow-up because the fixation was well maintained. The height index was significantly reduced because the nail tip width had definitely increased. Similar values for the height index were observed until the end of the follow-up period.

Although this study produced satisfactory clinical outcomes, research involving more than 11 patients is still necessary. It is also necessary to investigate the risk of recurrence through over 3–5 years of long-term follow-up. There were four follow-up losses because the condition of each patient was improved and there was no disruption to daily life. In addition, there were total seven patients who had more than 1 year of follow-up. Those patients did not show any complications or other functional problems as well. However, more systematic long-term studies and clinical comparisons with other procedures are warranted. In addition, more detailed observation of relevant clinical conditions in patients with severe complications, such as diabetes and renal disease, is needed.

Here, we proposed a new technique that allows for precise removal of bony osteophytes underneath the nail bed by lifting the nail plate. This reduces unnecessary bony removal and prevents bony destruction. Skin necrosis and ischemic changes that may occur due to the flap can also be prevented with this technique. Because there is no touching area other than the nail plate, there is no risk of interference with circulation. Removing inflammation helps with wound healing and fills the areas with granular tissues. This surgical technique can be applied to both severe bony deformity and severe nail deformity, and it is not difficult to perform.

The nail plate and bed reconstruction technique can be a useful technique considering that it facilitates precise anatomical correction compared to other previous techniques, causes few complications such as infections, and offers good clinical results.