Treatment of pincer nails / 中华皮肤科杂志

Pincer nails are a kind of nail deformity characterized by abnormal thickening and distal transverse overcurvature of the nail plate,whose etiology and pathogenesis are still unclear.According to the morphology of the nail plate,pincer nails can be divided into three subtypes:common pincer nail (trumpet nail),tile-shaped nail,and plicated nail.Width index,height index and curvature index are objective indicators to evaluate the severity and therapeutic effect of the pincer nails.According to the classification and severity of the pincer nails,appropriate treatment methods can be adopted to improve the appearance of the nail plate and relieve clinical symptoms of patients.This review systematically summarizes the classification of,evaluation of the severity of and several therapeutic methods for pincer nails.

Nail Plate and Bed Reconstruction for Pincer Nail Deformity

Pincer nail deformity is a severe condition in which the nail bed becomes compressed and the nail shows an overcurvature. We retrospectively analyzed 13 pincer nail deformities treated using our nail plate and bed reconstruction technique. Visual analogue scale scores, the width of nail root, width of nail tip, height of nail tip, width index, and height index were assessed before and after surgery. The overcurvature was corrected after detachment of the nail plate. The nail fold was pushed underneath the nail plate and then fixed. The width of nail tip significantly increased after surgery (p < 0.05) and was maintained during follow-up. The height of nail tip decreased after surgery (p < 0.05). This nail plate and bed reconstruction technique is a simple and quick surgical method for correcting deformities and reduces risks of complications such as skin necrosis and infection compared to other existing surgical techniques. We recommend this efficient surgical technique for the treatment of pincer nails.

Surgical Correction Of Pincer-Nail Deformity Using Autologous Full Thickness Skin Graft: A Case Report

Pincer nail deformity is often undertreated although it is a cause of pain and disfigurement.This may be attributed to underdiagnosis and lack of awareness of the available treatmentoptions especially surgical options. Not many centres offer surgical correction of pincer naildeformity in Malaysia. We would like to describe a surgical method of correcting this deformity.

The Effectiveness of Surgical Correction of Pincer Nails Using Nail Bed Flap and Bilateral Partial Matrixectomy, with or without Osteophyte Removal / 대한피부과학회지

BACKGROUND: A pincer nail is characterized by the presence of an excessively curved and distorted nail across the transverse dimension. A multitude of therapeutic modalities have been implemented to treat this condition with limited efficacy. OBJECTIVE: We sought to evaluate the efficacy of surgery for pincer nail deformity with the use of the nail bed flap and bilateral partial matrixectomy, with or without osteophyte removal. METHODS: Nine patients (four patients: both great toe nails, five patients: single toe nail) with pincer nail deformities were treated with nail bed flap and bilateral partial matrixectomy, with or without osteophyte removal. Objective assessment was evaluated by use of the width index (width of the nail tip/width of the nail root) and height index (height of the nail tip/width of the nail tip). Subjective assessment was evaluated through patient global assessment (PGA) and use of the pain visual analogue scale as declared by patients. In addition, wound complications and recurrences were described. RESULTS: The width index and height index were improved (width index: 85.5%-->97%, height index: 54.3%-->3.4%). All of the patients claimed 'good' or higher in the PGA score. Relief of pain was shown in 100% of the cases. There was no recurrence during a 6- to 20-month period (mean time: 11.8 months) and no complications. CONCLUSION: Nail bed flap and bilateral partial matrixectomy with or without osteophyte removal as a surgical approach might be an effective and curative method of treatment for pincer nail deformity.

Pincer Nail Deformity Treated with Widening of the Nail Bed / 대한피부과학회지

Pincer nail deformity is a nail deformity characterized by a transverse overcurvature of the nail plate, which increases along the longitudinal axis. Many conservative and surgical treatment modalities have been reported. Conservative methods can be difficult to use in cases of severe deformity because of their high recurrence rate. Therefore, surgical techniques, including nail matricectomy or correction of the nail bed, have been preferred in these cases. Matricectomy is generally considered as the surgical treatment of pincer nail deformity because of low recurrence rate in the field of dermatology. However, poor cosmetic results (e.g. narrowing of nail plate) are frequently observed. We present here a case of pincer nail deformity in the left great toe in a 57-year-old man who was treated successfully with widening of the nail bed without matricectomy. This method is an effective surgical technique preserving the nail matrix for the correction of pincer nail deformity.

Correction of Pincer Nail Deformity Using Dermal Grafting

Pincer nail deformity is characterized by excessive curvature and distortion of the nail in the transverse dimension, and particularly at the distal part of the nail plate. This deformity leads to pinching off and loss of soft tissue in the affected digit, causing severe pain. Many treatment methods have been proposed; however, an effective long-term method preserving the nail matrix has not yet been established. We present here a case of pincer nail in the left thumb in a 49-year-old woman who was treated successfully with dermal grafting under the nail bed. We describe the surgical method and the treatment results. To the best of our knowledge, this is the first report in the Korean medical literature on the use of dermal grafting for the treatment of pincer nail deformity.

A Clinical Study of 35 Cases of Pincer Nails

BACKGROUND: Pincer nail is a nail deformity characterized by transverse overcurvature of the nail plate. Pincer nail can affect a patient's quality of life due to its chronic, recurrent course; however, there have been no clinical studies on the pincer nail condition in Korean patients. OBJECTIVE: The purpose of this study was to characterize the clinical findings and treatment of pincer nail. In addition, possible etiological factors were considered, and treatment efficacy was evaluated. METHODS: The medical records and clinical photographs of 35 patients (12 males, 23 females) who were diagnosed with pincer nail between August 1, 2005 and July 31, 2009 were studied. RESULTS: Patient age ranged from 10 to 77 (52.09+/-17.26) years, and there was a predominance of female (23 out of 35 patients, F:M=2:1). The mean duration of the disorder was 7.45 years (range 0.25~40); 85% had pincer nail for at least 1 year. In addition, 40% had a history of previous treatment and recurrence. There were 82.8% patients with the common type of pincer nails. The most commonly involved nails were both great toenails. Among 35 patients, nail grinding was started in 30 patients, and 25 patients showed clinical improvement with nail grinding. The width index increased and the height index decreased after treatment. The mean follow up period was 8.42 months (range 1~27), and 7 patients showed recurrence after 8.8 months (range 2~20). Among 35 patients, 5 patients were treated with nail extraction with matricectomy, and the symptoms resolved immediately. The mean follow up period was 7.6 months (range 0~19), and recurrence was not observed. Onychomycosis was also present in 37.1% of patients, and itraconazole pulse therapy for 3 months was added. CONCLUSION: The results of this study demonstrate the clinical features of pincer nail in Korean patients. The findings show that the common type of pincer nail was most common, and nail grinding as a conservative treatment greatly improved pincer nails despite a risk of recurrence. When onychomycosis was also present, oral antifungal therapy added to nail grinding resulted in a more rapid change in nail thickness and clinical improvement.

Matrixplasty for the Treatment of Pincer Nail with Nail Growth Plate Deformity / 대한족부족관절학회지

PURPOSE: The purpose of this study was to introduce the 'Matrixplasty' for the treatment of a severely incurved toenail with growth plate deformity and to report our results treating this disease entity. MATERIALS AND METHODS: Between January 2010 and May 2010, 48 consecutive patients (62 cases) underwent treatment of symptomatic incurved toenails with the 'matrixplasty'. The mean period of time at last follow-up was 14.0+/-1.3months. The recurrence rate and complication rate were evaluated. An American Orthopedic Foot and Ankle Society (AOFAS) forefoot hallux score was assigned and patients were evaluated at pretreatment and the last follow-up meeting. For evaluation of improvement in toenail shape, the center to edge angle of the toenail was measured at pretreatment and last follow-up. RESULTS: All ingrown toenails healed and the nail deformity was corrected within 3 weeks after the procedure. Among the 62 cases, four cases had recurred by the last follow-up. The mean pretreatment AOFAS forefoot hallux score was 73.1+/-12.8, and it improved to 98.7+/-1.1 by the last follow-up (p<0.01). The mean center to edge angle of the toenail improved from 53.3+/-12.9 degrees to 18.2+/-7.4 degrees by the last follow-up (p<0.01). Minor paronychia, which was managed with local wound dressing and oral antibiotics, was identified in eight cases. CONCLUSION: Matrixplasty showed excellent clinical results in the treatment of severe incurved toenail (pincer nail) and this procedure also showed great improvement of the deformed toenail and its growth plate.

Correction of Pincer Nail using Autogenous Dermofat Graft

PURPOSE: Pincer nail is a relatively rare deformity characterized by an increase in transverse curvature along the longitudinal axis of the nail. This curvature commonly increases from proximal to distal end of nail, leading to pinching, curling, and distortion of the underlying soft tissue and resulting frequently in severe pain. Numerous surgical procedures have been reported. Preserving the width of the nail in the correction of the pincer nail is very important for functional and aesthetic reasons. We report the results of the correction of the pincer nail using autogenous dermofat graft with a good result. METHODS: From May 2006 to September 2008, dermofat graft was performed in 6 patients with pincer nail. Patients were four women and two men, and the average age was 51. The affected digits were the unilateral great toes in four patients and the unilateral thumbs in two patients. Average follow-up period was 13 months. Surgical procedure was removal of nail using an elevator to avoid damage to the nail bed. An incision was created in distal portion of hyponychium. Paronychium was dissected from distal phalanx by periosteal elevator through incision of hyponychium and tunnel was made. Then dermofat grafts harvested from inguinal area were inserted into the tunnel. Finally, a silicone sheet was inserted eponychial fold for prevention of synechia. Objective assessment was evaluated by use of the width index and height index. RESULTS: All patients reported resolution of the pain and soft tissue pinching sensation that they had before the operation. There was good adherence between the nail plate and the underlying nail bed. The nails have regrown and were corrected in a normal and flattened appearance. The width index and height index were improved. CONCLUSION: The autogenous dermofat graft seems to provide an effective treatment of the pincer nail with preservation of the nail matrix.

A Clinical Study of Efficacy of Surgical Management for Pincer Nails / 대한피부과학회지

BACKGROUND: A pincer nail deformity is characterized by the presence of an excessively curved and distorted nail across the transverse dimension, particularly at the distal part of the nail plate. A multitude of therapeutic modalities has been implemented to treat this condition with limited efficacy. OBJECTIVE: We sought to evaluate the efficacy of surgery of a pincer nail deformity with the use of the modified Haneke's method. METHODS: Six patients (seven toenails and two fingernails) with pincer nail deformities were treated with the modified Haneke's method. Objective assessment was evaluated by use of the width index (width of the nail tip/width of the nail root) and height index (height of the nail tip/width of the nail root). Subjective assessment was evaluated by use of a visual analogue scale declared by patients. In addition, wound complications and recurrence were described. RESULTS: The width index and height index were improved (width index: 15.4%-->7.1%, height index: 63.9%-->1.9%). Relief of pain could be determined in 100% of the cases. For subjective assessment, all of the patients were satisfactory (more than "satisfactory": 100%). There was no recurrence during a 14 to 24 month period (mean time: 19.2 months). CONCLUSION: The modified Haneke's method as a surgical approach might be effective and the procedure is easy to perform for a pincer nail deformity.

A New Treatment for Severe Incurved Toenail(2 Cases Report) / 대한족부족관절학회지

Partial toenail ablation on both sides of the great toenail, unfolding the severely curved toenail, and application of a simple device for maintaining the unfolded state of the incurved toenail is described to treat severely incurved toenails (pincer nails). This technique alleviated symptoms and improved the shape of severely curved toenails of the greater toe.

A Case of Pincer Nail Treated with Nail Plate Separation / 대한피부과학회지

Pincer nail is a dystrophy characterized by an increase of transverse curvature along the longitudinal axis of the nail and reaches its greatest proportion at the distal part. We report a case of a 20-year-old woman with pronounced pincer nails on both toe nails. By median longitudinal incision with use of CO2 laser, her nail plate was separated, and aluminum splint was applied on nail plate. Her pain disappeared one month after treatment. The treated nail showed a normal shape even at the 12 months of follow-up. We recommend nail plate separation as a good method for treatment of pincer nail.

Surgical Treatment of Pincer Nail Associated with Osteophyte / 대한피부과학회지

A 63-year-old woman had pronounced pincer nail of her big toenails. Her nail condition was markedly painful and associated with the underlying osteophyte. Under digital anaesthesia the nail plate was completely avulsed and the lateral portions of the matrix were destroyed by electrodessication. Then a longitudinal incision of the distal nail bed was made to separate it from the underlying structure and to expose the osteophyte. The exposed osteophyte was removed and the nail bed was sutured. Tie-under sutures were used to hold the bed in the appropriate transverse curvature. With this surgical correction, the treated nail showed a normal shape at 18 months of follow-up.

A Case of Heredetary Pincer Nail Treated with Nail Grinding Method / 대한피부과학회지

Pincer nail is a rare disease with severe pain on the distal nail bed by soft tissue ischemia. We report a case of ea 60-year-old woman who showed a hereditary form of pincer nail with some bulging appearing on her fingers. She was treated with a nail grinding method 3 times weekly, and her pain disappeared within a week without recurrence. We recommend nail grinding as a good method for treatment of pincer nail.