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Kim, Kim, and Yi: Short-Term Surgical Outcome of the Partial Nail Extraction in Ingrown Nail of Military Trainee: Is Matrixectomy Necessary?
Original Article

J Korean Foot Ankle Soc 2019;23(2):52-57.

Published online: 14 January 2019

DOI: https://doi.org/10.14193/jkfas.2019.23.2.52

Short-Term Surgical Outcome of the Partial Nail Extraction in Ingrown Nail of Military Trainee: Is Matrixectomy Necessary?

Jaeyoung Kim, Yoon Seok Kim*, Young Yi*

Department of Orthopedic Surgery, Armed Forces Daejeon Hospital, Daejeon, Korea

*Department of Orthopedic Surgery, Inje University Seoul Paik Hospital, Seoul, Korea

Corresponding Author: Young Yi Department of Orthopedic Surgery, Inje University, Seoul Paik Hospital, 9 Mareunnae-ro, Jung-gu, Seoul 04551, Korea Tel: 82-2-2270-0027, Fax: 82-2-2270-0023, E-mail: 20vvin@naver.com ORCID: https://orcid.org/0000-0002-5022-4251

Received 18 February 2019       Revised 21 May 2019       Accepted 3 June 2019

Copyright © 2019 Korean Foot and Ankle Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

An ingrown nail is common in military trainees who are exposed to highly demanding activities. Although the matrixectomy procedure has been the main treatment modality, several drawbacks may follow after the procedure, such as infection, periostitis, and continued pain that causes a delayed return to duty. This study examined the outcomes of a simple partial nail extraction with the hypothesis that this procedure may bring an earlier return to duty, lower the perioperative complications, and produce a comparable recurrence rate.

Materials and Methods:

The medical records of patients who had surgical treatment for an ingrown nail in the authors’ institution between April 2016 and December 2017 were reviewed retrospectively. Under the inclusion and exclusion criteria, 28 patients with a simple partial nail extraction (group A) and 29 patients with a partial nail extraction with matrixectomy (group B) were investigated. As the clinical outcome, the visual analogue scale (VAS) and satisfaction score, time to return to duty, complications, and recurrence rate were checked and compared between the groups.

Results:

The VAS scores of group B were significantly higher during the first (p<0.001) and second (p=0.026) follow-up week than group A. The time to return to duty was shorter in group A (7.8 days) than group B (10.1 days), and this difference was significant (p<0.001). Group B had five patients with complications, whereas group A had none (p=0.028). No differences in the recurrence rate (p=0.197) and patient satisfaction (p=0.764) were found between the groups.

Conclusion:

In this study, simple partial nail extraction in military trainees resulted in lower postoperative pain, lower complication rates, and earlier return to duty than the procedure with matrixectomy. Military trainees are temporarily exposed to highly demanding activities. Thus, a satisfactory outcome would be expected with simple partial nail extraction without performing a radical procedure, such as a matrixectomy.

Keywords: Toes, Ingrown nail, Military personnel, Partial nail extraction, Matrixectomy

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Figure 1.
Simple partial nail extraction. (A) Elevate nail edge with freer elevator. (B) Cut adequate amount of nail with scissor deep to proximal nail plate. (C) Elevate the proximal end of nail together with lateral nail horn. (D) Note the lateral nail horn is completely pulled out from the nail fold. (E) After partial nail extraction. (F) Excised nail. Note lateral nail horn (asterisk) is completely excised.
jkfas-23-52f1.tif
Figure 2.
Partial nail extraction. (A) Ingrown nail with inflammation. (B) The portion inside the red dotted line (partial nail with medial or lateral horn) is excised without an incision on proximal nail fold and eponychium. (C) Wound closure was not performed.
jkfas-23-52f2.tif
Figure 3.
Partial nail extraction with ma-trixectomy. (A) Ingrown nail with inflammation. (B) The portion inside the red dotted line (partial nail with medial or lateral horn and matrix) is ablated with an incision on proximal nail fold and eponychium. (C) Wound closure was performed.
jkfas-23-52f3.tif
Figure 4.
Mean visual analogue scale (VAS) score during follow-up period between two groups. *Statistically significant (p<0.05).
jkfas-23-52f4.tif
Table 1.
Baseline Characteristics of Patients
Characteristic Partial nail extraction group (n=28) Matrixectomy group (n=29) p-value*
Age (yr) 21.2±1.0 21.3±1.1 0.823
BMI (kg/m2) 24.6±3.3 24.0±2.5 0.490
Side 0.889
Right 13 14
Left 15 (53.6) 15 (51.7)
Side 0.337
Medial 18 (64.3) 15 (51.7)
Lateral 10 (35.7) 14 (48.3)
Heifetz stage 0.903
2 15 (53.6) 16 (55.2)
3 13 (46.4) 13 (44.8)

Values are presented as mean±standard deviation or number (%). BMI: body mass index. *Comparing partial nail extraction group and the matrixectomy group.

Table 2.
Comparison of Visual Analogue Scale (VAS) Score between Partial Nail Extraction Group and Matrixectomy Group during Follow-Up Period
VAS score Partial nail extraction group Matrixectomy group p-value
Preoperative VAS 4.1±1.0 4.0±1.1 0.604
VAS at week 1 1.2±0.4 2.0±0.8 <0.001
VAS at week 2 0.4±0.6 0.8±0.6 0.026
VAS at week 3 0.1±0.3 0.1±0.4 0.729

Values are presented as mean±standard deviation. *Comparing partial nail extraction group and the matrixectomy group.

Table 3.
Outcome of Treatment with Simple Partial Nail Extraction or Matrixectomy
Outcome Partial nail extraction group (n=28) Matrixectomy group (n=29) p-value*
Return to duty (d) 7.8±1.6 10.1±2.5 <0.001
Recurrence 2 (7.1) 2 (6.9) 0.197
Complications 0 (0) 5 (17.2) 0.028
Satisfaction 8.8±0.8 8.7±0.8 0.764

Values are presented as mean±standard deviation or number (%). *Comparing partial nail extraction group and the matrixectomy group.

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