Surgical management of extensive hypertrophic scarring of the halluces secondary to a decade of untreated onychocryptosis: An illustrative case report

Abstract

Extensive hypertrophic scarring of the halluces secondary to chronic onychocryptosis is a rare condition, which causes significant physical and psychosocial effects. In this case, a 31-year-old male developed large lesions on both great toes after he delayed treatment of chronic hallucal onychocryptosis for over a decade. Current treatment options for hypertrophic and keloid lesions in the foot and ankle vary considerably and differentiation is critical for appropriate treatment planning. In this case, surgical excision with total matrixectomy (modified Zadik-Syme) was considered optimal management. Histopathology testing confirmed the diagnosis of irritated hypertrophic scar secondary to onychocryptosis. The patient was monitored closely and at 3 months post-operatively, the incisional scars exhibited progressive maturation, and there was no recurrence of the lesions and no nail regrowth. Furthermore, the halluces were only marginally shorter providing good function and cosmesis. At the long-term follow-up consultation (5.5 years), the patient indicated complete satisfaction and had returned to regular footwear and social activities. Chronic onychocryptosis can trigger and facilitate proliferation of large benign keloid-like fibrous lesions; excision with total matrixectomy can provide an excellent long-term outcome.

Huge hypertrophic scar secondary to chronic ingrown toe nail mimicking tumor: A case report

“…A previously published report by Samaras et al, a case with a large periungal soft tissue mass associated with onychocryptosis lasting more than 10 years presented similar gross appearance to our case. [1] However, it was different from our case in that our case had ulcer at the tip of the hypertrophic scar. In the abovementioned case, the patient had a large sized mass-like lesion around the ingrown nail without genetic predisposition to keloid formation.…”

“…After complete excision, nail matrixectomy, and distal tuft resection were performed, satisfactory results were obtained in a long-term follow-up of 5.5 years. [1] Similarly, in the present case, treatment was delayed due to psychological issue of the patient. As a result, a very large mass was generated by repeated inflammation caused by irritation of the ingrowing nail.…”

“…Unlike keloid formation with a strong genetic predisposition, histological confirmation is required for scarring formation that does not have a traumatic event causing keloid formation or occurring at an advanced age or at an uncommon site. [1] Besides keloids, other conditions such as dermatofibroma, dermatofibrosarcoma, desmoid tumor and giant cell tumor must also be considered. Other benign lesions such as epidermal and mucoid cyst may occur.…”

“…Hypertrophic scar occurs within 4 to 8 weeks following a wound infection or other traumatic skin injuries. [1,2] Hypertrophic scars are contained within the site of injury. They might regress over time.…”

Large Lobular Capillary Hemangioma Associated with Ingrown Toenail: Histopathological Features and Case Report

“…In chronic ingrown toenail, hypergranulation tissue with or without fibrosis can occur following chronic soft tissue inflammation.Trauma can contribute to initial GT and can trigger and facilitate proliferation or histological transformation of large tissue, which can generally exceed normal tissue margins. Several reports have described different benign and malign transformations from secondary GT to chronic onychocryptosis [ 10 , 11 ].…”