Repairation of composite distal soft tissue defect of thumb and finger with mini toenail flap / 中华显微外科杂志

To introduce the repairation procedure of composite distal soft tissue defect of thumb and finger with mini toenail flap. Methods From June, 2015 to June, 2018, 7 cases with composite tissue defect at 7 distal fingers, including 5 thumbs, 1 index finger and 1 middle finger, were reconstructed with mini toenail flap transfer.The flap sizes which were raised during the operation ranged from 4.5 cm×3.0 cm-3.0 cm×1.5 cm.The donor sites were covered by toe phalanx shortening, V-Y advancement flap and local pedicle flap. Microsurgical routine treatment was made after the operation, and followed-up regularly. Results Seven flaps of 7 cases completely sur-vived without any necrosis. All the wounds at the donor sites healed well. All patients were followed-up for 6-36 months. The motive, sensor and cosmetic result were satisfied. In sensory function, the two-point discrimination dis-tance could restore to be 4-6 mm. Conclusion The mini toenail flap transfer is a reliable and suggested method.It can anatomically restored the distal digit sensor function with cosmetic contour, and regain the motive, sensory func-tion and satisfied cosmetic appearance.

A Study of the Quality of Life in Patients with Toenail Onychomycosis / 대한피부과학회지

BACKGROUND: Onychomycosis is a chronic fungal nail disease that may have a profound effect on quality of life (QOL). OBJECTIVE: The purpose of this study was to evaluate the QOL in patients with toenail onychomycosis using the onychomycosis quality of life questionnaire (ONYCHO) and to determine the factors influencing the QOL of toenail onychomycosis patients. METHODS: A total of 102 adults (mean age, 59.54 years) with toenail onychomycosis who visited our department between July 2017 and June 2018 completed the ONYCHO, which consists of statements pertaining to social, emotional, and symptom problems. All patients with toenail onychomycosis had been diagnosed by positive direct microscopic examination. RESULTS: Most of the patients demonstrated significantly reduced QOL. The degree of QOL impairment differed between subgroups. Both social (p<0.01) and emotional (p<0.05) impairments were more conspicuous in the female than in the male patients, although there were no differences according to symptoms. Patients with more extent of toenail involvement were more affected by onychomycosis in all three ONYCHO scales (p for trend<0.05). In terms of the type of toenail onychomycosis, the degrees of social (p for trend<0.05), emotional (p for trend<0.05), and symptom (p for trend<0.01) impairment were more prominent in patients with total dystrophic onychomycosis than in those with superficial white onychomycosis and distal and lateral subungual onychomycosis. A tendency toward better QOL in terms of social problems, but not emotional or symptom problems, was associated with a longer duration of the disease (B, 8.95, 95%CI, 0.99–16.91). CONCLUSION: Although toenail onychomycosis is not a life-threatening disease, it has a significantly negative impact on the overall QOL of patients, which should be a focus of concern.

Independent correlates of the toenail chromium level and the association between the chromium level and dyslipidemia / 한국영양학회지

PURPOSE: The number of patients with dyslipidemia have been increasing steadily over the past few decades in South Korea. The association between the chromium level and chronic disease has attracted considerable interest, but few studies have been conducted on the Korean population. The aim of this study was to identify the dietary and non-dietary correlates of the toenail chromium level, and evaluate the association between the toenail chromium level and dyslipidemia. METHODS: The baseline data of an ongoing prospective cohort study in Yeungnam area in South Korea were analyzed. A total of 500 participants aged 35 years or older who completed questionnaires on their demographics, lifestyle characteristics, and medical information were included. The toenail chromium level was analyzed by neutron activation analysis. The dietary intake was assessed using a validated 146-item semi-quantitative food frequency questionnaire. The blood lipid profiles were obtained from medical examinations conducted by the Korean National Health Insurance Service or medical institutions. RESULTS: Higher chromium levels were associated with the residential area (urban), higher education level, higher intakes of noodles and vegetables, and lower intake of fruits. Multiple logistic regression analysis showed that the toenail chromium levels were not associated significantly with the prevalence of dyslipidemia (odds ratio: 0.99, 95% confidence interval: 0.61 ~ 1.60). CONCLUSION: This study is the first study in Korea to determine the independent correlates of the toenail chromium levels and the association between chromium exposure and dyslipidemia. These findings provide useful scientific evidence for the development of chromium intake guidelines for the Korean population.

Clinical Research on the Partial Excision of Nail Matrix Combined with Phenolic Ablation in the Treatment of Ingrowing Toenail / 现代生物医学进展

Objective:To investigate the clinical efficacy of partial excision of nail matrix combined with phenolic ablation in the treatment of ingrowing toenail.Methods:115 patients(148 toenails) with ingrowing toenail treated in the Central hospital of Wuhan from October 2004 to May 2013 were selected for this study.The patients were divided into two groups,53 patients(67 toenails) admitted from October 2004 to December 2007 were considered as the observation group and treated with Partial excision of nail matrix,62 patients(81 toenails) admitted from January 2008 to May 2013 were considered as the control group and treated with Partial excision of nail matrix and phenolic ablation.The bleeding time,pain relief time,healing time,recurrences after one year and satisfaction rate of two groups were compared.Results:The wounds of 148 toenails were healing.The Bleeding time,pain relief time,recurrences after one year in the control group (1.85:±:0.42days,13.25± 2.17hours) were lower than the observation group (2.69± 0.53 days,21.54± 2.56hours),and healing time in the control group (11.32± 2.37days) were longer than the observation group (8.93± 2.06 days)(P＜0.05),the recurrence rate and overall satisfaction rate of observation group and control group were 6.15％,12.5％ and 97.06％,91.07％.Conclusion:Partial excision of nail matrix combined with phenolic ablation was more effective in the treatment of ingrowing toenail than surgical excisional techniques.

A Case of Toenail Onychomycosis Due to Aspergillus terreus / 대한의진균학회지

Onychomycosis is caused by dermatophytes usually, but some species of nondermatophytic molds and yeasts are also associated with invasion of nails. Aspergillus(A.) terreus is a nondermatophytic mold which is opportunistic filamentous fungus in all environments. We report a case of onychomycosis caused by A. terreus in a 60-year-old male. The patient showed brownish yellow discoloration with hyperkeratotic change on the distal and lateral portion of both toenails. Direct microscopic examination of scraping on the potassium hydroxide preparation revealed septate hyphae and repeated cultures on Sabouraud's dextrose agar showed the velvety, cinnamon brown colonies. Biseriate and compactly columnar phialides that cover upper vesicle with conidial structure were shown in the slide culture. The DNA sequence of internal transcribed spacer (ITS) region of clinical sample was 99% match to that of A. terreus strain ATCC 20542 (GenBank accession number GU256759.1). We confirmed A. terreus by KOH mount, colony, light microscopic morphology and DNA sequence analysis. The patient was treated with 200 mg oral itraconazole daily and topical 5% amorolfine nail lacquer for 3 months.

Great Toenail Dystrophy: A Single-Center Experience and Review of the Literature / 가정의학회지

BACKGROUND: There have been a few reported cases of congenital great toenail dystrophy (GTND), described as a congenital malalignment of the great toenails. However, acquired GTDN is rare, and has not been documented extensively. This study aimed to describe the clinical features of 21 patients with acquired GTND. METHODS: Twenty-one patients with acquired GTND who visited Yeouido St. Mary's Hospital between June 2005 and August 2012 were retrospectively reviewed. RESULTS: The mean patient age was 43.1 years (range, 17 to 88 years), and the cohort predominantly comprised women (18/21). In our experience, all acquired GTND patients presented with yellow or yellow-brownish chromonychia, onychotrophy, and onycholysis. Conservative treatment with tape methods and grinding, as well as nail extraction, was provided and yielded little improvement in any case. CONCLUSION: This study provides initial data on the nail changes affecting the great toenail, such as yellowish chromonychia, onychomadesis, and onycholysis. These data may help physicians to distinguish various nail disorders, including onychomycosis, congenital malalignment of the great toenails, and yellow nail syndrome.

A Case of Toenail Onychomycosis Due to Aspergillus sydowii Infection / 대한의진균학회지

Onychomycosis is caused by dermatophytes usually, but some species of nondermatophytic molds and yeasts are also associated with invasion of nails. Aspergillus sydowii is a nondermatophytic mold which is opportunistic filamentous fungus in all environments. We report a case of onychomycosis caused by A. sydowii in a 65-year-old male. The patient showed yellowish discoloration with hyperkeratotic change on the distal and lateral portion of both great toenails. Direct microscopic examination of scraping on the potassium hydroxide preparation revealed dichotomous septate hyphae and repeated cultures on Sabouraud dextrose agar showed the same blue green velvety colonies. Biseriate phialides that cover entire vesicle with conidial structure resembling Penicillium were shown in the slide culture. The DNA sequence of internal transcribed spacer (ITS) region of clinical sample was 99% match to that of A. sydowii strain XWSFJJ1 (GenBank accession number FJ461692). We confirmed A. sydowii by KOH mount, colony, light microscopic morphology and DNA sequence analysis. The patient was treated with 250 mg oral terbinafine daily and topical 5% amorolfine nail lacquer for 3 months.

Efficacy of Trichloroacetic Acid in Patients with Toenail Onychomycosis: Pilot Study with 14 Patients / 대한의진균학회지

BACKGROUND: Various methods have been employed for treatment of onychomycosis. These methods can be categorized as topical, oral, or device-related. Among them, oral therapies have been regarded as the gold standard for treatment. However, the efficacy of oral therapies on onychomycosis remains limited and safety may be an issue, leaving many patients in need of alternative treatments. As an alternative treatment for onychomycosis, topical therapies are under investigation with great interest. OBJECTIVE: We conducted an investigation on the efficacy of trichloroacetic acid (TCA) as a new therapeutic option in treatment of onychomycosis. METHODS: Fourteen patients with onychomycosis in both great toenails, which was confirmed by fungal examination, were enrolled. About 0.1 ml of 100% TCA solution was applied on one great toenail of the patients eight times at an interval of one week. The other great toenail of the patients was treated with vehicle. RESULTS: At the end of the treatment period, clinical improvement of TCA-treated great toenails with onychomycosis was observed in eleven out of 14 patients. By contrast, no clinical improvement was observed in vehicle-treated great toenails with onychomycosis. Irritant contact dermatitis of the periungual nail folds occurred in 29% as an adverse effect. CONCLUSIONS: Topical solution of TCA may become a new therapeutic option for treatment of patients with onychomycosis who desire alternatives to oral antifungal agents.

Clinical Study of Efficacy of Super Elastic Wire for Ingrown Nails of Great Toe / 대한피부과학회지

BACKGROUND: Ingrown toenail is one of the most common nail complaints. It occurs mostly on the great toes, where is an excessive lateral nail growth into the nail fold, leading to painful irritation, inflammation, and growth of the granulation tissue. Many treatments have been described, but these classic treatment modalities may lead to severe damage of the nail fold or frequent relapses. OBJECTIVE: We attempted to evaluate the therapeutic efficacy of super elastic wire (SE-wire, Machiwire(R)), a non-invasive treatment for ingrown toenails. METHODS: Fifteen patients with ingrown toenail were treated with super elastic wire. 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: 75.0%-->90.0%, height index: 76.5%-->27.7%). Pain was relieved in 100% of the cases. For subjective assessment, all of the patients were satisfied (more than "satisfactory": 100%). There were two relapsed cases during 5 to 12 month period (mean time: 9 months). CONCLUSION: We recommend super elastic wire method as an alternative treatment for ingrown toenail, because it is simple, easy to perform, noninvasive, effective, and well-tolerated.

Ingrown toenails.

Onychocryptosis or ingrown toenail is a very common pathology of the toenail unit, chiefly affecting adolescents and young adults. The ingrown toenail is responsible for disabling complaints like pain and difficulty in walking. It is associated with significant morbidity, hampering the quality of life as it interferes with sporting activities, school, or work. It principally occurs in the hallux. It is ascribed to poor trimming of the nails in combination with local pressure due to ill-fitting footwear, hyperhidrosis, poor foot hygiene and nail abnormalities. Pain, swelling and discharge are the main clinical features. Four stages of the condition have been described. Diagnosis is usually evident, but it should be differentiated from subungual exostosis and tumors of the nail bed. The current standard of care focuses on conservative treatment like the gutter splint technique in the initial stages, and in cases that are resistant to medical management or recurrent, surgical correction is the treatment of choice. There are various surgical techniques that are described in literature. Although there is no ideal technique, lateral nail plate avulsion with lateral matricectomy by phenol is commonly used and reported to be more effective in reducing recurrences. The aim of this review article is to focus on this common pathology of the nail, the various techniques employed in management and aid in the selection of treatment according to the stage and severity of the disease.

Half hallux toenail flap transplantation to repair the distal segment finger defect / 中华显微外科杂志

Objective To discuss the treatment of half hallux toenail flap transplantation for reconstruction of the distal segment finger defect. Methods Based on using the first plantar/dorsal metatarsal artery, or toe artery as pedicle to cut off partial toenail together with toe abdomen flap or partial toenail to repair 64 cases which include 69 fingers with distal segment complete and partial defect,the distal skin avulsion,skin tube in postoperative plastic,replantation failure and so on.Depending on the size of the donor foot wound use the first dorsal metatarsal artery,second toe artery,the perforating branch of peroneal artery or plantar metatarsal artery flap to cover the wound, and then observe the appearance of the finger and foot donor site after operation. Results The finger pulp was full and elastic,nail bed of the toe was well healing,nail groove which originated from the reconstructed nail fold was shallow,the appearance wos realistic,all feelings were recover,two-point discrimination was 4 to 5 millimeter,the donor toe was plump like the original one in appearance,patients were all satisfied with the reconstructed finger and the toe shape,after a follow-up from 3 month to 4 years. Conclusion Half hallux toenail flap transplantation is an effective way to repair the distal segment finger defect.

Reconstruction of the Finger Nail Using Microsurgical Composite Toe Nail Transfer

PURPOSE: The presence of normal fingernail is important for the hand function and cosmetic appearance. We studied the results of the microsurgical reconstruction of the defected fingernail using composite toenail transfer. MATERIALS AND METHODS: From March of 2004 to May of 2009, eleven fingernails were reconstructed using microsurgical composite toenail transfer in 10 patients with a mean age of 27 years (range, 13 to 47 years). There were three thumbs, five index fingers, and three long fingers. Whole fingernail was destructed in three cases and remaining eight cases had partial nail defect. Toenail was grafted from great toe in eight cases and from second toe in three cases. Five cases were harvested as an osteoonychocutaneous flap, two as a endoosteoonychocutaneous flap and four as an onychocutaneous flap. RESULTS: All cases survived without any tissue necrosis. One arterial obstruction had occurred one day after surgery, which was resolved by repeated decompression and reanastomosis of the artery. All fingernails regenerated successfully. According to the rating system including assessment of shape, size and thickness of nail, nail pinch, pain, and patient's satisfaction, ten cases were rated as excellent and one as good. All patient's were satisfied with their hand function and appearance. CONCLUSION: Microsurgical composite toenail transfer can be an acceptable surgical reconstruction for the fingernail defect after trauma, providing satisfactory hand functions and cosmetic appearance.

A Case of Ingrown Toenail Associated with Tinea Unguium Treated with K-D(R) Wire / 대한의진균학회지

Ingrown toenail is a common disorder resulting from various etiologies including excessive external pressure, ill-fitting footwear, and improper nail-trimming techniques. Patients commonly present with pain in the affected nail but with progression, drainage, infection and difficulty walking occur. It is often difficult to manage and frequently recurs, despite the multitude of treatment techniques that have been reported. Conservative therapy is a reasonable approach in patients with a mild to moderate ingrown toenail that do not have significant pain, substantial erythema, or purulent drainage from the lateral nail edge. We report a case of ingrown toenail in a 45-year-old female treated with K-D(R) wire, a corrective device. After application of K-D(R) wire for 3 weeks, ingrown toenail healed and the nail deformity was corrected.

Demographic and lifestyle factors and selenium levels in men and women in the U.S

Selenium is an antioxidant trace element linked to cardiovascular disease and cancer. Although diet is a major source, relatively little else is known about independent determinants of selenium levels in free-living humans. In this study, we aimed to investigate the independent demographic, lifestyle, and dietary determinants of selenium levels in 1,997 men and 1,905 women in two large prospective U.S. cohorts. Toenail selenium levels were quantified using neutron activation analysis. Diet, geographic residence, demographic, and environmental factors were assessed by validated self-administered questionnaires. Multivariate generalized linear models were conducted to assess the independent relations of these factors with toenail selenium levels, correcting for measurement error in the diet. In multivariable-adjusted analyses, independent predictors of higher selenium were male gender (6.3% higher levels); living in West and Northern-Midwest U.S. regions (8.9% and 7.4% higher than Southern-Midwest regions, respectively); consumption of beef and bread products (between 0.7 - 2.5% higher per daily serving); and selenium supplement use (6.9% higher than non-users); whereas cigarette smoking (5-10% lower than never smokers) , older age (0.6% lower per 5 years), and consumption of eggs, white rice, dairy products, coffee, and alcohol (between 0.1 to 2.0% lower per daily serving) were associated with lower selenium. Multiple dietary and non-dietary factors independently predicted selenium levels, suggesting that both consumption and non-dietary processes (e.g., related to oxidant status) may affect levels. Significant geographic variation in selenium levels exists in the US.

Donor site repair of great toe-nail flap in finger reconstruction surgery / 中华显微外科杂志

ObjectiveTo explore methods of donor repair of the great toe-nail flap in finger reconstruction surgery.MethodsFrom December 1998 to December 2010, various kinds of flaps were used in 511 donor sites to repair the great toe-nail flaps,including:32 dorsal pedal artery flaps;twenty-four first dorsal metatarsal artery flaps;twenty-one second dorsal metatarsal artery flaps;forteen anterior malleolar flaps;seventeen medial tarsal artery flaps;seventy-nine lateral tarsal artery flaps;one hundred and six plantar metatarsal flaps,seventy-nine flaps from second toe;fifteen flaps from mid/lower leg and 124 freed flaps.ResultsAfter postoperative 6 months to 11 years of follow-up, repaired donor sites of great toe-flaps all survived successfully,with ideal outlook and function.ConclusionThere are many kinds of methods for donor site repair of the great toe-nail flap,and each kind of method has its own advantages and disadvantages. Among these flaps, plantar pedal artery flap and free groin flap are amony the best ones.

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.

A Treatment for Incurved Toenails Using a K-D(R)

Treatments of severely incurved toenails cause anatomical changes and cosmetic problems, even though they provide adequate symptom relief. Incurved toenail patients treated with a K-D(R)(S&C Biotech, Seoul, South Korea) the new device for correcting curved nail deformity were investigated retrospectively. This study surveyed 12 patients(18 cases) who had been treated for severe ingrown toenails using K-D(R) from May 2008 to March 2009, and examined their subjective satisfaction before and after the treatment. The average age of the participants was 39(ranging from 27 to 52), and 8 of them were male and 4 female. The treatment was applied after the patients were given a thorough explanation about the tool and the treatment, and questionnaire surveys were conducted before the treatment and after 3 months on the average from the treatment. In the survey, the respondents were asked about pain, restriction on activities, and the selection of shoes. For each item, symptoms with a given point were presented, and the respondents' scores were compared between the surveys before and after the treatment. According to the results of the questionnaire survey, pain increased from 14 out of 40 before the treatment to 39 after, activity restriction increased from 11 to 30, and shoe selection increased from 20 to 30. The average total score increased from 45 to 98, and this suggests a considerable enhancement in the patients' subjective satisfaction. The average period of the application of K-D(R) was 20.3+/-9.4 days, and in all the cases, ingrown toenails were corrected within three weeks.

Surgical Treatment for Acquired Malalignment of the Toenail / 대한피부과학회지

Malalignment of the toenail is a rare deformity that is characterized by lateral deviation of the nail plate with respect to the longitudinal axis of the distal phalanx. The condition may be congenital or acquired. The acquired forms of malalignment may result from trauma or surgical intervention. However, there are only a few reports that have focused on surgical treatment for this condition. We present here a case of a 24-year-old woman who had this nail problem for 1 year and she was successfully treated with the surgical approach. We also discuss the probable mechanism of iatrogenic malalignment.

Preferred Oral Antifungal Treatment in Toenail Onychomycosis Patients / 대한의진균학회지

BACKGROUND: Treatment of toenail onychomycosis requires long term oral medication of antifungal agent. So many factors such as preferred treatment option can affect the compliance and cure rate. OBJECTIVES: The objective of the present study was to identify most preferred treatment options for toenail onychomycosis patients. METHODS: This study was undertaken on 190 patients treated toenail onychomycosis, who visited Hanyang University Guri hospital, Konkuk University hospital and Asan Medical center during the period between March 2008 to April 2008. RESULTS: 1. Mean age of patients was 53.5+/-15.5 years old, 108 patients (56.8%) were female and 82 patients (43.2%) were male. 2. Mean duration of disease was 7 years 11 months (7.9+/-8.8 years). 3. The motives of treatment for toenail onychomycosis were 'ugly appearance' (39.8%) and 'pruritus' (33.9%). 4. Seventy six percent of patients had history of treatment for toenail onychomycosis. Most of them (43%) visited dermatologist's office and 14% of them used folk remedy. 5. Continuous therapy was the most common method (47%) in previous treatment. And it was the most common treatment option irrespective of age, disease duration and gender. 6. The most preferred treatment option was also continuous therapy (57%). And 69% of patients who received continuous therapy preferred it, but it was only 48% in pulse therapy group and 38% in weekly pulse therapy group. 7. Sixty six percent of the toenail onychomycosis patients had associated disease. CONCLUSIONS: Continuous therapy was the most convenient method for toenail onychomycosis patients who visited general hospital.

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.