Management of skin necrosis after chemical matrixectomy with sodium hydroxide in ingrown toenail

Abstract

Ingrown nail (unguis incarnatus) is a common condition associated with discomfort and morbidity. Thoughtful treatment choice and patient care by an experienced center is important for overall success.

A 28 years old female patient presented with symptoms of chronic unguis incarnatus and a skin necrosis on right great toe. Patient history revealed that symptoms has aggravated after a recent treatment chemical matrixectomy into soft tissue with 10% sodium hydroxide following 10% acetate neutralization to the nail root by another center. Physical examination showed 1.8x0.7 cm full-thickness skin necrosis. Our team surgically removed the ingrown nail area with “Winograd” method. After debridement of necrosis, exposed extensor hallucis longus tendon was covered with a local transposition flap. Patient returned to work with full capacity on postop week 3. During 3 years of follow up no recurrence was observed. Treatment significantly improved mean patients foot function index (Preop:6.4±3.1 vs. 12months:1, p< 0.001) with high cosmetic satisfaction.

It is not safe nor recommended to perform unproven, subdermal application based operations for unguis incarnatus patients. Well established surgical lateral matrix excision or ablation techniques are safe and successful treatment options. Evidence based care is important to achieve successful results and minimal morbidity and deformity.