Significance of Surgery to Correct Anatomical Alterations in Pincer Nails

Abstract

Background: Pincer nail deformity and its causes can pose a therapeutic challenge. Ill-fitting shoes and subungual exostosis of the toes may be attributed to pincer nail formation. However, in some cases, the causes of pincer nail deformity could not be determined. The role of mechanobiology in nail configuration and deformities has rarely been considered. Objective: The present study investigated the effectiveness of surgical procedures to correct pincer nail deformity, in terms of anatomical changes measured by radiographs. Methods: Two surgical procedures, nail bed widening with matrixectomy or a dermal graft, were used on 30 nails in 20 patients with pincer deformity. Changes in the width, height, and curvature indices were assessed. Radiographs were obtained to evaluate the presence of osteophytes and measure the interphalangeal angle in terms of mechanobiology in nail configuration. Results: Preoperative and postoperative assessment results revealed marked improvement objectively and subjectively. The mean width index was greater after surgery than that before surgery (84.4% vs. 64.8%). Both mean height and curvature indices were smaller after surgery than before preoperative (23.0% vs. 76.7% and 1.3% vs. 2.2%, respectively). Conclusion: Nail bed widening with matrixectomy, which corrects anatomical alterations in pincer nails, is suggested to be suitable for patients with pincer nail deformity. (Ann Dermatol 31(1) 59∼65, 2019

Improvements in pincer nail deformity occur earlier and last longer when acetylcysteine gel is added to an overcurvature‐correcting device: Results of a phase 3, multicenter, randomized, vehicle‐controlled, investigator‐blinded study

“…Although the recurrence rate following surgery may be lower than that following conservative treatment, invasive surgery requires specialist skills and is associated with several risks including significant levels of pain, impaired appearance of the affected area, secondary infection, wound necrosis, and sensory impairment. 20,21 Patient characteristics (such as age, presence of uncontrolled diabetes, or arterial insufficiency) may also preclude surgical intervention. 22 For many patients, conservative treatment using an overcurvature correction device is able to provide a permanent solution without the need for more aggressive intervention, 23,24 although repeat procedures may be necessary to prevent recurrence and achieve long-term success.…”

“…Currently, either conservative or surgical procedures can be performed to treat pincer nail, 1 and although there is no consensus on a standard treatment pathway, conservative treatment should generally be considered in the first instance. Although the recurrence rate following surgery may be lower than that following conservative treatment, invasive surgery requires specialist skills and is associated with several risks including significant levels of pain, impaired appearance of the affected area, secondary infection, wound necrosis, and sensory impairment 20,21 . Patient characteristics (such as age, presence of uncontrolled diabetes, or arterial insufficiency) may also preclude surgical intervention 22 .…”

Incisão em T invertido com remoção de osteófitos, no tratamento da unha em pinça

“…8 O risco de unhas em pinça é maior nos pés em comparação às unhas das mãos, e sua taxa de incidência é duas vezes maior entre as mulheres do que entre os homens. 4 A deformidade da unha em pinça deve ser diagnosticada e tratada, pois afeta não apenas a aparência, mas também a função do dedo e a qualidade…”

“…3 Também há relatos de alterações nos pés devido ao uso de sapatos apertados ou por osteoartrite causando unhas em pinça. 4 Nesta patologia, a unha comprime o leito ungueal causando dor durante a caminhada ou exercício, além de problemas estéticos. 5 A dor pode surgir devido à incorporação da unha nas suas dobras laterais e no leito ungueal, que se torna mais elevado distalmente.…”