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Partial Matrix Excision or Segmental Phenolization for Ingrowing Toenails
Carina L. E. Gerritsma-Bleeker, MD;
Joost M. Klaase, MD, PhD;
Robert H. Geelkerken, MD, PhD;
Jo Hermans, PhD;
Rob J. van Det, MD
Arch Surg. 2002;137:320-325.
Objective To decide whether partial nail extraction with phenolisation or with partial excision of the matrix should be the standard treatment in patients with ingrowing toenails of the hallux.
Design Randomized clinical trial with 12-month follow-up evaluations performed by observers who did not know which procedure was applied.
Setting Outpatient department of a surgical teaching hospital.
Patients Fifty-eight consecutive patients with a total of 63 ingrowing toenails were randomized.
Intervention Thirty-four partial matrix excisions ("matrix" group) and 29 phenolizations ("phenol" group) were performed.
Main Outcome Measures Recurrence rate, postoperative morbidity (pain, wound exudates, and scar discomfort), and time to complete recovery (wearing shoes, performing normal activities/work).
Results Recurrences were seen after 7 procedures in the matrix group and also after 7 procedures in the phenol group, of which patients were symptomatic and required a second operation in 4 and 3 instances, respectively. None of the observed differences in wound healing, postoperative pain, and recovery were statistically significant.
Conclusions Partial matrix excision and phenolization are equally effective in treating ingrowing toenails. Because the use of the toxic agent phenol should be avoided, partial matrix excision is the preferable procedure. But in view of the high recurrence rate, there is a need for further improvement of the treatment of ingrowing toenails.
From the Department of Orthopaedic Surgery, Martini Hospital, Groningen, the Netherlands (Dr Gerritsma-Bleeker); the Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands (Drs Klaase, Geelkerken, and van Det); and the Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand (Dr Hermans).
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