Relapses of ingrown toenail: causes and treatment features

Abstract

Introduction. The recurrent course of an ingrown toenail remains a serious problem to this day, despite the centuries-old history of its study. Among outpatient patients, the incidence of this disease reaches 10% and does not tend to decrease, and among the population, the incidence of ingrown toenail is 3.4%. The aim of the work was to study the causes of recurrent ingrown toenail and the effectiveness of using a laser beam in the treatment of this pathology.Material and methods. The authors analyzed the causes of recurrent ingrown toenail in 66 patients after various surgical interventions for the period from 1990 to 2020.Results and discussion. The following causes of relapse of the disease were identified: removal of the entire nail plate not according to indications, carrying out marginal resection of the nail on the affected side with the preservation of the nail plate matrix, performing removal of granulations in the nail roller area with the preservation of the nail, underestimating the importance of anti-inflammatory drug treatment in the postoperative period, as well as the importance of correcting metabolic processes in patients with concomitant pathology. A clinical case is presented: a patient with a non-healing wound after four surgeries due to an ingrown toenail with a recurrent course. The patient underwent a Schmiden surgery with resection of the “ingrown edge” of the right first toe nail and removal of infected granulations using laser irradiation of the wound and careful treatment of the matrix area in the projection of the removed part of the nail. In the postoperative period, bandages with ointment based on chloramphenicol and methyluracil were used for local treatment. Recovery occurred on the fourteenth day.Conclusion. In order to reduce the number of relapses of the disease, it is recommended to perform a matrixectomy of the bed of the removed nail plate using laser or radio wave radiation.