Randomized clinical trial of surgical technique and local antibiotics for ingrowing toenail.
BACKGROUND
The aim of this study was to investigate different surgical techniques for treating ingrowing toenails (IGTNs) and to determine the value of a locally applied antibiotic after intervention.


METHODS
One hundred and twenty-three patients with IGTN were assigned randomly to one of four groups. All patients had partial nail avulsion. This was combined with excision of the matrix or application of phenol, with or without local application of gentamicin afterwards. All procedures were performed by one physician. The primary outcome measure was symptomatic recurrence of IGTN.


RESULTS
One hundred and seventeen patients were available for follow-up. Phenol gave significantly better results than matrix excision with respect to recurrence (including regrowth and spike formation) after 1 year (P < 0.001). In terms of signs of infection, there was no significant difference between phenol and matrix excision after 2 days (P = 0.224) or 1 week (P = 0.501). Antibiotics had no effect in reducing the risk of infection after 2 days (P = 0.989) or 1 week (P = 0.676), or in reducing the rate of recurrent IGTN at 1 year (P = 0.187). If regrowth or spike formation is included, the effect is even less significant (P = 0.876).


CONCLUSIONS
Partial nail avulsion with phenolization gave better results than partial avulsion with matrix excision. Local antibiotics did not reduce signs of infection or recurrence. Use of phenol did not produce more signs of infection than matrix excision.
Bos
A M C
AM
Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
van Tilburg
M W A
MW
van Sorge
A A
AA
Klinkenbijl
J H G
JH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009263:Nails, Ingrown / Q000601:surgery*; D019800:Phenol / Q000627:therapeutic use*; D012008:Recurrence; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014034:Toes; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D005839:Gentamicins; D019800:Phenol