title: Protruded and nonprotruded subungual exostosis: Differences in surgical approach.
abstract: BACKGROUND
  In subungual exostosis surgery, repair of the damaged nail bed and surgical excision of the mass without damaging the nail bed is important. The ideal method of surgery is still unclear. This study is done to qualify the effects of different surgical methods on outcome measures in different types of subungual exostosis.
  
  
  METHODS
  Fifteen patients, operated with a diagnosis of subungual exostosis between January 2008 and June 2012, were evaluated. Protruded masses were excised with a dorsal surgical approach after the removal of the nail bed and nonprotruded masses were excised through a"fish-mouth" type of incision.
  
  
  RESULTS
  The mean age of the patients in protruded subungual exostosis group was 17.3 years (range 13-22 years) and this group consisting of seven female and two male patients. The patients were followed up for a mean of 14.1 ± 4.8 months. The mean age of the patients in the nonprotruded subungual exostosis group was 14.6 years (range 13-16 years) and consisting of six female patients. The patients were followed up for a mean of 11.6 ± 2.9 months. The results were positively affected by changing the surgical approach depending on whether or not the exostosis is protruded from the nail bed. All patients had healthy toe nails in the postoperative period without any signs of recurrence.
  
  
  CONCLUSIONS
  In patients with a protruded subungual exostosis, the mass should be removed by a dorsal approach with the removal of the nail and injury to the nail bed should be repaired. In patients with a nonprotruded subungual exostosis, the mass should be excised through a "fish-mouth" type incision at the toe tip without an iatrogenic damage.
authors.affiliation: Department of Orthopaedics and Traumatology, Sakarya Training and Research Hospital, Sakarya, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Başar
authors.affiliation: Department of Orthopaedics and Traumatology, Sakarya Training and Research Hospital, Sakarya, Turkey.
authors.forename: Mustafa Erkan
authors.initials: ME
authors.lastname: Inanmaz
authors.affiliation: Department of Physical Medicine and Rehabilitation, Akyazı State Hospital, Sakarya, Turkey.
authors.forename: Betül
authors.initials: B
authors.lastname: Başar
authors.affiliation: Department of Orthopaedics and Traumatology, Sakarya Training and Research Hospital, Sakarya, Turkey.
authors.forename: Emre
authors.initials: E
authors.lastname: Bal
authors.affiliation: Department of Orthopaedics and Traumatology, Sakarya Training and Research Hospital, Sakarya, Turkey.
authors.forename: Kamil Çağrı
authors.initials: KÇ
authors.lastname: Köse
keywords: Nail bed surgery; subungual exostosis; surgical exposure