Correction of Pincer Nail Deformities Using a Modified Double Z-Plasty Young Joo Cho, MD,* Jae Hoon Lee, MD,* Dong Jun Shin, MD,* and Woo Young Sim, MD†
BACKGROUND Pincer nail is a deformity characterized by excessive transverse curvature of the nail plate that increases distally for which many conservative and surgical corrective modalities have been recommended. OBJECTIVE The purpose of this study is to investigate the outcomes and safety of modified double Z-plasty in the management of symptomatic pincer nail. MATERIALS AND METHODS Modified double Z-plasty has been performed on 20 great toes in 12 patients from January 2008 to December 2013. The mean age of patients was 43 (range: 20–65) years. Three men and 9 women were enrolled. Visual analogue scale (VAS) score for pain, transverse angle, and width indices were investigated at the initial and the last follow-up. The average follow-up period was 2.4 years. RESULTS All parameters showed significant improvement after surgery. Between the initial and last followup, the mean VAS score fell from 7.4 to 0.3, the mean transverse angle improved from 50 to 166°, and the mean width index improved from 65.4% to 97%. In all patients, the deformity was successfully eliminated with no recurrences. No complications were identified. CONCLUSION Modified double Z-plasty provides a long-standing effective treatment for pincer nail deformity with an excellent esthetic result. The authors have indicated no significant interest with commercial supporters.
A
pincer nail causes pinching of the lateral nail plate into soft tissue, leading to severe pain, secondary infections, inconvenience in daily life, cosmetic problems, and limitation in shoe selection.1–5 To correct pincer nail deformities, several conservative and surgical treatment methods have been suggested, with limited success. As of yet, there is no established standard method for treating pincer nail deformity.4,6–8 Among the suggested treatments, there are several surgical procedures that can be divided into 2 groups: those that destroy the nail matrix and those that preserve it. Among the surgical category is the 5-flap Z-plastyprocedure,4 which preserves the nail matrix but has shown a limitation in its ability to flatten the distal nail bed. To overcome this limitation, the authors modified the design of the Z-plasty to improve its ability to flatten the distal end of the nail.
The purpose of this study was to retrospectively analyze the efficacy of the authors’ modified double Z-plasty for the correction of pincer nail deformities.
Materials and Methods A total of 20 toes in 12 patients who had undergone a modified double Z-plasty for the treatment of pincer nail deformities in the great toe between January 2008 and December 2013 were analyzed retrospectively. There were 9 female and 3 male patients. The mean age of the patients was 43 (range: 20–65) years. The patients had had pincer nails for a mean of 6.4 (range: 3–10) years. Eight patients had bilateral pincer nail deformities. Two cases had undergone nail extraction; there was no treatment history in the other cases. Fungal infection of the nail was not observed in any case at the initial visit. According to radiographic
Departments of *Orthopedic Surgery, and †Dermatology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea © 2015 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved. ISSN: 1076-0512 Dermatol Surg 2015;41:736–740 DOI: 10.1097/DSS.0000000000000356
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·
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© 2015 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
CHO ET AL
findings, none of the pincer nail deformities were caused by a tumor. The visual analogue scale (VAS) (score: 0–10) was used to assess nail-associated pain. Using clinical photographs taken preoperatively, the transverse angle and width index applied were measured as in the study by Kim and colleagues.9 The transverse angle was defined as the angle of nail curvature in the front view, and the width index was defined as the ratio of the width of the nail tip to the width of the nail root. The width index approaching 0% is indicative of an increased taping of the nail plate. Operative Procedures A digital nerve block of 1% lidocaine was provided. A toe tourniquet was applied to the proximal phalanx of the great toe. After total nail extraction was performed, double Z-plasties were designed on the tip of the great toe. Each Z-design starts from the distal lateral part of the nail bed. Unlike the design by Mutaf and colleagues,4 a vertical incision was added to the flap that included the nail bed. A vertical skin incision that would divide the 2 Z-designs on the tip of the toe was not performed (Figure 1A). A skin incision was then made down to the periosteum, and the flap was elevated. The nail bed was elevated as a proximally based flap, exposing the distal phalanx. The excess osteophytic tissue located on the dorsal surface of the distal phalanx was rongeured to obtain a flat dorsal surface of the distal phalanx. After flattening the flap including the elevated nail bed, the skin around the tip of the nail bed was removed in parallel with the nail bed (Figure 1B). The elevated skin flap was then transposed in a routine Z-plasty. The transposed flap was sutured to the remaining skin at the tip of the nail
bed with 5-0 nylon sutures to flatten and widen the nail bed in a transverse direction (Figure 1C). After suturing was complete, the nail bed was covered with an artificial nail. The authors recommended to begin ambulation on the same day as surgery and to not limit daily living activities. The sutures were removed 12 days after surgery, and the artificial nail was removed 3 weeks after surgery. Statistical Analyses The authors conducted the paired t-tests to evaluate difference in subjective pain and objective parameters between the preoperative evaluation and the final follow-up time points. SPSS (version 17.0; SPSS Inc., Chicago, IL) was used for all analyses. A p < 0.05 was considered significant.
Results The mean follow-up period was 2.4 years (range: 7 months–5.5 years). By postoperative Week 2, all patients were performing their daily living activities without pain. All patients’ nails grew in a natural form within 6 months. Patients’ mean preoperative VAS score, which was measured while they were wearing a shoe, was 7.4 (range: 5–8). The mean score improved to 0.3 (range: 0–1) by the last follow-up. Nail deformities in all cases were successfully corrected, and all 12 patients were satisfied with the operative outcomes (Figures 2 and 3). The preoperative mean transverse angle was 50° (range: 0–80°), which increased to 166° (range: 160–170°) by the last followup. The mean width index, which was 65.4% (range: 40%–80%) preoperatively, increased to 97% (range: 86%–100%) by the last follow-up. Postoperative complications, such as secondary infections, skin
Figure 1. Illustrative views of the surgical technique. (A) A modified double Z-plasty is designed on the tip of the affected toe with a thick black line. (B) The incisions are performed, and the skin flaps are elevated. The skin within the striped area is removed to lengthen the nail plate. (C) The flaps are transposed and sutured in a routine Z-plasty manner.
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© 2015 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
PINCER NAIL DEFORMITIES
Figure 2. A 20-year-old man with a severe pincer nail deformity on the left great toe. (A) Preoperative view. (B) Intraoperative design. (C) Immediate postoperative view. (D) Postoperative view, 6 months after surgery.
necrosis, and sensory disturbance, were not observed. No cases reported recurrence of nail deformities at the last follow-up.
Discussion A pincer nail is a deformity with an incidence of 0.9% in a randomized population, according to Jemec and colleagues.10 The deformity most frequently involves the great toe, but it can occur in any nail. Although the etiology of a pincer nail is not clearly known, pincer nail deformities are usually attributed to one of several diseases or conditions, including psoriasis, trauma, developmental anomaly, beta-blocker ingestion, allergic reaction, epidermal cyst, subungual exostosis, arthritis, or wearing ill-fitting shoes.5 Baran and colleagues11 reported that the overcurvature is probably due to exostoses of the distal phalanx, leading to an
increase in torque in the outgrowing nail plate. Recent studies, however, suggest that an osteophyte of the distal phalanx is not a cause of but rather a result of a nail overcurvature.2,12 They hypothesize that the physical difference between the ventral and dorsal sides of the nail plate is the cause of a pincer nail, and the harder dorsal nail plate causes the plastic ventral nail plate to be contracted, resulting in nail bed shrinkage or constriction.9 Although several conservative and surgical treatment options have been introduced to correct pincer nails, there is no standardized method for achieving rapid improvement, low recurrence, and cosmetically appealing results.8 Superelastic wire13 or formable acrylic treatment,14 aluminum splint,15 shape memory alloy device,9 and thioglycolic acid and wire16 have been suggested as conservative options. They can
Figure 3. A 59-year-old woman with a pincer nail deformity on her left great toe. (A) Preoperative view. (B) Postoperative view, 3 years after surgery.
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© 2015 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
CHO ET AL
cause morphologic changes and relieve pain, but the changes are usually unstable and it takes several months to a year before improvements are seen. Surgical options result in lower recurrence compared with conservative methods but may also cause severe pain, delayed improvement, cosmetically unacceptable results, or complications, including secondary infection, wound necrosis, or sensory disturbance.2,6,9,12,17 Surgical procedures are categorized based on whether they destroy or preserve the nail matrix. The first group includes Zadik’s method,18 which results in cosmetically unsatisfactory outcomes because the nail matrix is destroyed. The second group includes dermal graft3 and homograft dermis,5 both of which typically achieve similar outcomes. As an alternative, Kosaka and Kamiishi19 described a procedure that widens the nail bed in a transverse direction with vertical incisions at the distal end and sutures back in a zigzag pattern as in a classic W-plasty. Mutaf and colleagues4 treated a pincer nail by removing the osteophytic bone tissue located on the dorsal surface of the distal phalanx, which provided a flat surface for the nail bed before performing a 5-flap Z-plasty to widen the nail bed in a transverse direction. They yielded successful results without recurrence, but their design of a triangle-shaped flap was limited in how much it could flatten the distal end of the nail bed. To overcome this limitation, the authors modified part of the Z-plasty design in this study. The authors added a vertical incision to the flap that split the nail bed into 2 flaps. A vertical skin incision dividing the 2 Z-designs at the tip of the toe was not performed. After flattening the flap, including the elevated nail bed, the authors removed the skin around the 2 flaps in parallel with the nail bed. Then the transposed flap was sutured with 5-0 nylon sutures to flatten and widen the nail bed in a transverse direction. The authors’ method used the advantageous characteristics from the methods of Mutaf and colleagues4 and Kasaka and Kamiishi.19 In a retrospective study by Kim and colleagues9 using a shape memory alloy device that was recently used for conservative treatment, they improved the mean transverse angle from 86.4 to 149° and the mean
width index from 67.6 to 95.7° by the last follow-up. At postoperative Week 12, 2 cases (9.5%) reported recurrence. In the authors’ study, the transverse angle increased from a preoperative mean of 50 to 166° at the last follow-up and the width index improved from 65.4% to 97%, achieving a better correction than with a shape memory alloy device. Additionally, conservative treatment using the shape memory alloy device is inconvenient because the device has to be worn for a minimum of 3 weeks. The authors’ method is more comfortable and reliable because it requires no additional treatment after removing the sutures, and there were no recurrence at the last follow-up. Conclusion The modified double Z-plasty is effective for treating pincer nail deformities and achieving a good cosmetic result without recurrence.
References 1. Cornelius CE III, Shelley WB. Pincer nail syndrome. Arch Surg 1968;96: 321–2. 2. Kosaka M, Kusuhara H, Mochizuki Y, Mori H, et al. Morphologic study of normal, ingrown, and pincer nails. Dermatol Surg 2010;36:31–8. 3. Brown RE, Zook EG, Williams J. Correction of pincer-nail deformity using dermal grafting. Plast Reconstr Surg 2000;105:1658–61. 4. Mutaf M, Sunay M, Is¸ık D. A new surgical technique for the correction of pincer nail deformity. Ann Plast Surg 2007;58:496–500. 5. Zook EG, Chalekson CP, Brown RE, Neumeister MW. Correction of pincer-nail deformities with autograft or homograft dermis: modified surgical technique. J Hand Surg Am 2005;30:400–3. 6. Ozawa T, Yabe T, Ohashi N, Harada T, et al. A splint for pincer nail surgery: a convenient splinting device made of an aspiration tube. Dermatol Surg 2005;31:94–8. 7. Lane JE, Peterson CM, Ratz JL. Avulsion and partial matricectomy with the carbon dioxide laser for pincer nail deformity. Dermatol Surg 2004;30:456–8. 8. Lee JI, Lee YB, Oh ST, Park HJ, et al. A clinical study of 35 cases of pincer nails. Ann Dermatol 2011;23:417–23. 9. Kim JY, Park SY, Jin SP, Yoon HS, et al. Quick and easy correction of a symptomatic pincer nail using a shape memory alloy device. Dermatol Surg 2013;39:1520–6. 10. Jemec GB, Kollerup G, Jensen LB, Mogensen S. Nail abnormalities in nondermatologic patients: prevalence and possible role as diagnostic aids. J Am Acad Dermatol 1995;32:977–81. 11. Baran R, Haneke E, Richert B. Pincer nails: definition and surgical treatment. Dermatol Surg 2001;27:261–6. 12. Ghaffarpour G, Tabaie SM. A new surgical technique for the correction of pincer-nail deformity: combination of splint and nail bed cutting. Dermatol Surg 2010;36:2037–41.
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© 2015 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
PINCER NAIL DEFORMITIES
13. Moriue T, Yoneda K, Moriue J, Matsuoka Y, et al. A simple therapeutic strategy with super elastic wire for ingrown toenails. Dermatol Surg 2008;34:1729–32. 14. Arai H, Arai T, Nakajima H, Haneke E. Formable acrylic treatment for ingrowing nail with gutter splint and sculptured nail. Int J Dermatol 2004;43:759–65. 15. Kim KD, Sim WY. Surgical pearl: nail plate separation and splint fixation—a new noninvasive treatment for pincer nails. J Am Acad Dermatol 2003;48:791–2. 16. Okada K, Okada E. Novel treatment using thioglycolic acid for pincer nails. J Dermatol 2012;39:996–9.
740
17. Baran BR. Letter: pincer and trumpet nails. Arch Dermatol 1974;110: 639–40. 18. Zadik FR. Obliteration of the nail bed of the great toe without shortening the terminal phalanx. J Bone Joint Surg 1950;32:66–7. 19. Kosaka M, Kamiishi H. New strategy for the treatment and assessment of pincer nail. Plast Reconstr Surg 2003;111:2014–9.
Address correspondence and reprint requests to: Jae Hoon Lee, MD, 892 Dongnam-ro, Gangdong-gu, Seoul 134-727, Korea, or e-mail: [email protected]
DERMATOLOGIC SURGERY
© 2015 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Copyright of Dermatologic Surgery is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
BACKGROUND Pincer nail is a deformity characterized by excessive transverse curvature of the nail plate that increases distally for which many conservative and surgical corrective modalities have been recommended. OBJECTIVE The purpose of this study is to investigate the outcomes and safety of modified double Z-plasty in the management of symptomatic pincer nail. MATERIALS AND METHODS Modified double Z-plasty has been performed on 20 great toes in 12 patients from January 2008 to December 2013. The mean age of patients was 43 (range: 20–65) years. Three men and 9 women were enrolled. Visual analogue scale (VAS) score for pain, transverse angle, and width indices were investigated at the initial and the last follow-up. The average follow-up period was 2.4 years. RESULTS All parameters showed significant improvement after surgery. Between the initial and last followup, the mean VAS score fell from 7.4 to 0.3, the mean transverse angle improved from 50 to 166°, and the mean width index improved from 65.4% to 97%. In all patients, the deformity was successfully eliminated with no recurrences. No complications were identified. CONCLUSION Modified double Z-plasty provides a long-standing effective treatment for pincer nail deformity with an excellent esthetic result. The authors have indicated no significant interest with commercial supporters.
A
pincer nail causes pinching of the lateral nail plate into soft tissue, leading to severe pain, secondary infections, inconvenience in daily life, cosmetic problems, and limitation in shoe selection.1–5 To correct pincer nail deformities, several conservative and surgical treatment methods have been suggested, with limited success. As of yet, there is no established standard method for treating pincer nail deformity.4,6–8 Among the suggested treatments, there are several surgical procedures that can be divided into 2 groups: those that destroy the nail matrix and those that preserve it. Among the surgical category is the 5-flap Z-plastyprocedure,4 which preserves the nail matrix but has shown a limitation in its ability to flatten the distal nail bed. To overcome this limitation, the authors modified the design of the Z-plasty to improve its ability to flatten the distal end of the nail.
The purpose of this study was to retrospectively analyze the efficacy of the authors’ modified double Z-plasty for the correction of pincer nail deformities.
Materials and Methods A total of 20 toes in 12 patients who had undergone a modified double Z-plasty for the treatment of pincer nail deformities in the great toe between January 2008 and December 2013 were analyzed retrospectively. There were 9 female and 3 male patients. The mean age of the patients was 43 (range: 20–65) years. The patients had had pincer nails for a mean of 6.4 (range: 3–10) years. Eight patients had bilateral pincer nail deformities. Two cases had undergone nail extraction; there was no treatment history in the other cases. Fungal infection of the nail was not observed in any case at the initial visit. According to radiographic
Departments of *Orthopedic Surgery, and †Dermatology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea © 2015 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved. ISSN: 1076-0512 Dermatol Surg 2015;41:736–740 DOI: 10.1097/DSS.0000000000000356
·
·
736
© 2015 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
CHO ET AL
findings, none of the pincer nail deformities were caused by a tumor. The visual analogue scale (VAS) (score: 0–10) was used to assess nail-associated pain. Using clinical photographs taken preoperatively, the transverse angle and width index applied were measured as in the study by Kim and colleagues.9 The transverse angle was defined as the angle of nail curvature in the front view, and the width index was defined as the ratio of the width of the nail tip to the width of the nail root. The width index approaching 0% is indicative of an increased taping of the nail plate. Operative Procedures A digital nerve block of 1% lidocaine was provided. A toe tourniquet was applied to the proximal phalanx of the great toe. After total nail extraction was performed, double Z-plasties were designed on the tip of the great toe. Each Z-design starts from the distal lateral part of the nail bed. Unlike the design by Mutaf and colleagues,4 a vertical incision was added to the flap that included the nail bed. A vertical skin incision that would divide the 2 Z-designs on the tip of the toe was not performed (Figure 1A). A skin incision was then made down to the periosteum, and the flap was elevated. The nail bed was elevated as a proximally based flap, exposing the distal phalanx. The excess osteophytic tissue located on the dorsal surface of the distal phalanx was rongeured to obtain a flat dorsal surface of the distal phalanx. After flattening the flap including the elevated nail bed, the skin around the tip of the nail bed was removed in parallel with the nail bed (Figure 1B). The elevated skin flap was then transposed in a routine Z-plasty. The transposed flap was sutured to the remaining skin at the tip of the nail
bed with 5-0 nylon sutures to flatten and widen the nail bed in a transverse direction (Figure 1C). After suturing was complete, the nail bed was covered with an artificial nail. The authors recommended to begin ambulation on the same day as surgery and to not limit daily living activities. The sutures were removed 12 days after surgery, and the artificial nail was removed 3 weeks after surgery. Statistical Analyses The authors conducted the paired t-tests to evaluate difference in subjective pain and objective parameters between the preoperative evaluation and the final follow-up time points. SPSS (version 17.0; SPSS Inc., Chicago, IL) was used for all analyses. A p < 0.05 was considered significant.
Results The mean follow-up period was 2.4 years (range: 7 months–5.5 years). By postoperative Week 2, all patients were performing their daily living activities without pain. All patients’ nails grew in a natural form within 6 months. Patients’ mean preoperative VAS score, which was measured while they were wearing a shoe, was 7.4 (range: 5–8). The mean score improved to 0.3 (range: 0–1) by the last follow-up. Nail deformities in all cases were successfully corrected, and all 12 patients were satisfied with the operative outcomes (Figures 2 and 3). The preoperative mean transverse angle was 50° (range: 0–80°), which increased to 166° (range: 160–170°) by the last followup. The mean width index, which was 65.4% (range: 40%–80%) preoperatively, increased to 97% (range: 86%–100%) by the last follow-up. Postoperative complications, such as secondary infections, skin
Figure 1. Illustrative views of the surgical technique. (A) A modified double Z-plasty is designed on the tip of the affected toe with a thick black line. (B) The incisions are performed, and the skin flaps are elevated. The skin within the striped area is removed to lengthen the nail plate. (C) The flaps are transposed and sutured in a routine Z-plasty manner.
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© 2015 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
PINCER NAIL DEFORMITIES
Figure 2. A 20-year-old man with a severe pincer nail deformity on the left great toe. (A) Preoperative view. (B) Intraoperative design. (C) Immediate postoperative view. (D) Postoperative view, 6 months after surgery.
necrosis, and sensory disturbance, were not observed. No cases reported recurrence of nail deformities at the last follow-up.
Discussion A pincer nail is a deformity with an incidence of 0.9% in a randomized population, according to Jemec and colleagues.10 The deformity most frequently involves the great toe, but it can occur in any nail. Although the etiology of a pincer nail is not clearly known, pincer nail deformities are usually attributed to one of several diseases or conditions, including psoriasis, trauma, developmental anomaly, beta-blocker ingestion, allergic reaction, epidermal cyst, subungual exostosis, arthritis, or wearing ill-fitting shoes.5 Baran and colleagues11 reported that the overcurvature is probably due to exostoses of the distal phalanx, leading to an
increase in torque in the outgrowing nail plate. Recent studies, however, suggest that an osteophyte of the distal phalanx is not a cause of but rather a result of a nail overcurvature.2,12 They hypothesize that the physical difference between the ventral and dorsal sides of the nail plate is the cause of a pincer nail, and the harder dorsal nail plate causes the plastic ventral nail plate to be contracted, resulting in nail bed shrinkage or constriction.9 Although several conservative and surgical treatment options have been introduced to correct pincer nails, there is no standardized method for achieving rapid improvement, low recurrence, and cosmetically appealing results.8 Superelastic wire13 or formable acrylic treatment,14 aluminum splint,15 shape memory alloy device,9 and thioglycolic acid and wire16 have been suggested as conservative options. They can
Figure 3. A 59-year-old woman with a pincer nail deformity on her left great toe. (A) Preoperative view. (B) Postoperative view, 3 years after surgery.
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DERMATOLOGIC SURGERY
© 2015 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
CHO ET AL
cause morphologic changes and relieve pain, but the changes are usually unstable and it takes several months to a year before improvements are seen. Surgical options result in lower recurrence compared with conservative methods but may also cause severe pain, delayed improvement, cosmetically unacceptable results, or complications, including secondary infection, wound necrosis, or sensory disturbance.2,6,9,12,17 Surgical procedures are categorized based on whether they destroy or preserve the nail matrix. The first group includes Zadik’s method,18 which results in cosmetically unsatisfactory outcomes because the nail matrix is destroyed. The second group includes dermal graft3 and homograft dermis,5 both of which typically achieve similar outcomes. As an alternative, Kosaka and Kamiishi19 described a procedure that widens the nail bed in a transverse direction with vertical incisions at the distal end and sutures back in a zigzag pattern as in a classic W-plasty. Mutaf and colleagues4 treated a pincer nail by removing the osteophytic bone tissue located on the dorsal surface of the distal phalanx, which provided a flat surface for the nail bed before performing a 5-flap Z-plasty to widen the nail bed in a transverse direction. They yielded successful results without recurrence, but their design of a triangle-shaped flap was limited in how much it could flatten the distal end of the nail bed. To overcome this limitation, the authors modified part of the Z-plasty design in this study. The authors added a vertical incision to the flap that split the nail bed into 2 flaps. A vertical skin incision dividing the 2 Z-designs at the tip of the toe was not performed. After flattening the flap, including the elevated nail bed, the authors removed the skin around the 2 flaps in parallel with the nail bed. Then the transposed flap was sutured with 5-0 nylon sutures to flatten and widen the nail bed in a transverse direction. The authors’ method used the advantageous characteristics from the methods of Mutaf and colleagues4 and Kasaka and Kamiishi.19 In a retrospective study by Kim and colleagues9 using a shape memory alloy device that was recently used for conservative treatment, they improved the mean transverse angle from 86.4 to 149° and the mean
width index from 67.6 to 95.7° by the last follow-up. At postoperative Week 12, 2 cases (9.5%) reported recurrence. In the authors’ study, the transverse angle increased from a preoperative mean of 50 to 166° at the last follow-up and the width index improved from 65.4% to 97%, achieving a better correction than with a shape memory alloy device. Additionally, conservative treatment using the shape memory alloy device is inconvenient because the device has to be worn for a minimum of 3 weeks. The authors’ method is more comfortable and reliable because it requires no additional treatment after removing the sutures, and there were no recurrence at the last follow-up. Conclusion The modified double Z-plasty is effective for treating pincer nail deformities and achieving a good cosmetic result without recurrence.
References 1. Cornelius CE III, Shelley WB. Pincer nail syndrome. Arch Surg 1968;96: 321–2. 2. Kosaka M, Kusuhara H, Mochizuki Y, Mori H, et al. Morphologic study of normal, ingrown, and pincer nails. Dermatol Surg 2010;36:31–8. 3. Brown RE, Zook EG, Williams J. Correction of pincer-nail deformity using dermal grafting. Plast Reconstr Surg 2000;105:1658–61. 4. Mutaf M, Sunay M, Is¸ık D. A new surgical technique for the correction of pincer nail deformity. Ann Plast Surg 2007;58:496–500. 5. Zook EG, Chalekson CP, Brown RE, Neumeister MW. Correction of pincer-nail deformities with autograft or homograft dermis: modified surgical technique. J Hand Surg Am 2005;30:400–3. 6. Ozawa T, Yabe T, Ohashi N, Harada T, et al. A splint for pincer nail surgery: a convenient splinting device made of an aspiration tube. Dermatol Surg 2005;31:94–8. 7. Lane JE, Peterson CM, Ratz JL. Avulsion and partial matricectomy with the carbon dioxide laser for pincer nail deformity. Dermatol Surg 2004;30:456–8. 8. Lee JI, Lee YB, Oh ST, Park HJ, et al. A clinical study of 35 cases of pincer nails. Ann Dermatol 2011;23:417–23. 9. Kim JY, Park SY, Jin SP, Yoon HS, et al. Quick and easy correction of a symptomatic pincer nail using a shape memory alloy device. Dermatol Surg 2013;39:1520–6. 10. Jemec GB, Kollerup G, Jensen LB, Mogensen S. Nail abnormalities in nondermatologic patients: prevalence and possible role as diagnostic aids. J Am Acad Dermatol 1995;32:977–81. 11. Baran R, Haneke E, Richert B. Pincer nails: definition and surgical treatment. Dermatol Surg 2001;27:261–6. 12. Ghaffarpour G, Tabaie SM. A new surgical technique for the correction of pincer-nail deformity: combination of splint and nail bed cutting. Dermatol Surg 2010;36:2037–41.
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© 2015 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
PINCER NAIL DEFORMITIES
13. Moriue T, Yoneda K, Moriue J, Matsuoka Y, et al. A simple therapeutic strategy with super elastic wire for ingrown toenails. Dermatol Surg 2008;34:1729–32. 14. Arai H, Arai T, Nakajima H, Haneke E. Formable acrylic treatment for ingrowing nail with gutter splint and sculptured nail. Int J Dermatol 2004;43:759–65. 15. Kim KD, Sim WY. Surgical pearl: nail plate separation and splint fixation—a new noninvasive treatment for pincer nails. J Am Acad Dermatol 2003;48:791–2. 16. Okada K, Okada E. Novel treatment using thioglycolic acid for pincer nails. J Dermatol 2012;39:996–9.
740
17. Baran BR. Letter: pincer and trumpet nails. Arch Dermatol 1974;110: 639–40. 18. Zadik FR. Obliteration of the nail bed of the great toe without shortening the terminal phalanx. J Bone Joint Surg 1950;32:66–7. 19. Kosaka M, Kamiishi H. New strategy for the treatment and assessment of pincer nail. Plast Reconstr Surg 2003;111:2014–9.
Address correspondence and reprint requests to: Jae Hoon Lee, MD, 892 Dongnam-ro, Gangdong-gu, Seoul 134-727, Korea, or e-mail: [email protected]
DERMATOLOGIC SURGERY
© 2015 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Copyright of Dermatologic Surgery is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
