Surgical Nail Intervention Techniques Comparison

Introduction

Critical appraisal is a methodical progression through which the strengths and weaknesses of a research study can be acknowledged. This progression enables the reader to gauge the study’s worth and whether its conclusions are dependable. The most significant element of critical appraisal is attentive appraisal of the study design; however, other steps, such as evaluation of the statistical methods used, interpretation of the findings and possible conflicts of interest are also important. Finally, reflection of the importance of the research to one’s own patients will help clinicians recognise the most relevant, high-quality studies available to monitor their own clinical practice

In nail surgery, the hallux is typically involved; however surgery may also include the lesser toes (DeLauro 2004). Nail surgery may be accessed for an assortment of pathologies; onychocryptosis, an ingrowing nail being the most common; the patient can develop a tender and draining lesion, along with the formation of granulation tissue at the side of the pierced skin (Heidelbaugh 2009); onychogryphosis or onychomycosis. Any of these indicators can cause a great deal of distress, and they often have an influence on everyday activities experienced by the patient (Yang 2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers).

Surgical nail interventions intend to eradicate the troublesome portion of the nail (in combination with matrix obliteration), thus, relieving symptoms and hopefully averting regrowth of the bothersome nail.

Surgical nail interventions are most likely to be of use when the ingrowing toenail is at a more severe stage of development (stage II and stage III).

There are variations of different surgical nail interventions. Virtually every surgical nail intervention aims to remove the bothersome part of the nail and destroy the underlying matrix so that there is a slight risk of recurrence. The techniques used nowadays are mostly modifications of the techniques originally described by Winograd, Zadik, and Ross (Ross 1969; Winograd 1929; Zadik 1950). The terminology in the classification of the surgical nail interventions is based on the description of the technique, instead of the names of the inventor of the technique.

Table 1 shows technique and combinations of techniques which are used as surgical nail interventions.

Table 1: Surgical Nail Intervention Techniques

Table 2: Surgical Nail Interventions Study Critique Tool

In most nail surgery, the use of epinephrine with lidocaine is not recommended due to the probable risk of tissue necrosis resulting from prolonged vasoconstriction and extended wound healing due to tissue hypoxia. (Dauber et al 1994, Salasche 2005). The use of epinephrine is especially hazardous to patients with diabetes mellitus, elderly patients and in vascular insufficiency, or vasculitis and it should be avoided if possible.

Table 3: Characteristics of excluded studies.

Nail Surgery Pathway

Figure Proposed Nail Surgery Pathway

Conclusion

In the studies comparing a surgical nail intervention to a surgical nail intervention with application of phenol, the addition of phenol is probably more effective in preventing recurrence and regrowth. Because there is only one study in which surgical nail interventions in both study arms were equal and where the addition of phenol leads to better results, more studies have to be done to confirm these outcomes. A more invasive surgical intervention with application of phenol is likely to reduce the risk of recurrence more effectively than a less invasive surgical intervention with the application of phenol.

Postoperative interventions do not decrease the risk of postoperative infection or postoperative pain, or give a shorter healing time. This means that there is no evidence to give antibiotics to prevent postoperative infections.

References

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Zadik FR, (1950) Obliteration of the nail bed of the great toe without shortening the terminal phalanx. The Journal of Bone and Joint Surgery; 32(1):66–7.