ONYCHOGRYPHOSIS COMPLICATED WITH NAIL INCARNATION: PECULIAR FEATURES OF A SURGICAL ELIMINATION AND COMPREHENSIVE TREATMENT
DOI:
https://doi.org/10.11603/2415-8798.2016.4.7148Keywords:
onychogryphosis, ingrown nail, comprehensive treatment, removal of the nail plate.Abstract
Certain peculiar features of the clinical course and comprehensive treatment were studied, including surgical removal of the nails for patients with onychogryphosis associated with an ingrown nail (onychocryptosis, nail incarnation). Over the five-year period we examined and treated 98 patients of 52–86 years old with onychogryphosis (67 men – 68.37 % of the sample and 31 women – 31.63 %), 38 of them had diabetes mellitus and 24 had metabolic syndrome. Three variants of dermatophytoma are differentiated: front center – with up to 25 % eroded nail – 45 cases, subtotal – from 25 to 70 % (without capturing the growth plate) – 38 cases, total – from 70 to 90 % (with affected growth plate of the nail) – other 15 cases. In all cases dermatophytoma affected distal and central part of the nail bed. Analysis of subonychial scraping allowed stating the prevalence of red trichophytia, where in 74 % cases it was associated with mold, in 26 % cases it was associated with yeast fungi; in 31 % cases it was associated with the bacterial flora. Mycotic associated hyponychial panaritium was diagnosed for 16 patients with onychogryphosis (16.33 % of the sample), purulent paronychia was diagnosed for 11 patients (11.22 %), other 5 patients of this group got eponychial abscess (5.10 %). Methods of surgical treatment of uncomplicated onychogryphosis and onychogryphosis complicated with recurrent nail incarnation were improved considering patho and morphogenetic properties of destructive onychomycosis; removal of the mycotic affected nails of these patients should reasonably be conducted through onycholized structures with simultaneous removal of dermatophytoma, hyperkeratosis, and in-growth areas with hypergranulation. Removal of affected nails for patients with poly onychomycosis was performed through successive stages at add-back of certain systemic "pulses" with itraconazole. Patients with such combined pathology got 4–5 five-day system "pulses" of 400 mg/day itraconazole therapy at a simultaneous use of hepatoprotectors and correction of comorbid pathology. Provided adequate surgical treatment, in addition to standard decompression stage (complete removal of the nail plate), contained antirecurrent component to prevent from repeated in-growth. After less traumatic onychectomy the patients from treatment group had healing time (crust formation) of operative wounds equal to 12–23 days (average duration of healing is 16 days), particularly the patients with diabetes mellitus after similar removal of nails had healing time equal to 16–23 days (average duration of healing is 19 days) and the indices approached the indices of control group; after "classical" onicectomia indices of the patients with diabetes mellitus were 24–30 days respectively (average duration of healing is 26 days), indices of the control group were 14–22 days (average duration of healing is 18 days). No postoperative complications were ascertained.
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