Skin Bridging Secondary to Ingrown Toenail

Abstract

Ingrown toenails are painful conditions that especially affect young people and may become chronic if not treated. We describe a case of chronically inflamed ingrown toenail left untreated for three years. In the physical examination, skin bridging and epithelialization was observed in midline secondary to soft tissue hypertrophy of the lateral nail matrixes. Epithelized fibrous tissue was cut across the lateral nail matrix and left for secondary healing. Partial matrixectomy was applied and the remnants were cauterized in compliance with the Winograd procedure after removal of the nail. Our case is an advanced condition which is the second report in the literature. Skin bridging secondary to excess soft tissue hypertrophy can be observed in untreated bilateral Heinfert or Frost stage 3 ingrown nails. This rare case can be classified as advanced stage 3 disease or stage 4.

Severe ingrown toenail with hypertrophic skin bridging: A case report and review of the literature

“…2 Typically conservative treatment is the treatment modality of choice for mild or stage 1, with surgical intervention reserved for stage 2 and above. 3 The case described in this report does not fit the classification system as it is a rare and atypical occurrence with the need for surgical intervention due to skin bridging across the dorsal nail plate with absence of infection.…”

“…3,4 We present a case where the medial and lateral nail folds have significant hyperplasia to the effect of spanning the mid-portion of the hallux nail plate. Seyfettinoglu et al have previously described the Winograd procedure in a case study for use in similar hypertrophied cases.…”

A case of ingrown nail using buckle VHO‐Osthold® Perfect as a method of conservative treatment

“…From improper cutting of the plate or selection of the wrong footwear to deformations caused by changes in the skeletal system of the anatomical structure of the foot, or diseases of the nail plate itself. [6][7][8][9][10] Although surgical treatment can achieve a rapid effect by completely removing the completely ingrown nail or the surrounding tissue, it should be borne in mind that these are invasive actions and can lead to deformations of the nail plate at a later stage of its growth. Complications following surgical interventions may include significant postoperative pain, prolonged wound healing, risk of bone infection or other infections, and a longer recovery period compared to conservative methods.…”

“…Chronic and untreated inflammation can lead to serious complications such as secondary infections with Paronychia purulent exudate, hypergranulation of Caro luxurians, severe soreness of the entire nail apparatus, continuous bleeding, and fibrosis and loss of elasticity of the nail folds. 5,6 Predisposing factors for ingrowing nails are disproportionate width of the nail plate in comparison with the nail bed, size, and massiveness of the nail folds, disturbed plate growth caused by injury or improper selection of footwear, inadequate care (excessive cutting of nail angles), orthopedic deformations of the foot and postsurgery deformations, overweight (also in pregnant women), excessive sweating and maceration of the skin, and varied growth of the nails and feet during puberty. [6][7][8] The main factor contributing to IN is poorly fitting footwear (including working footwear), which causes biomechanical disturbances between the big toes and other toes when walking.…”

“…5,6 Predisposing factors for ingrowing nails are disproportionate width of the nail plate in comparison with the nail bed, size, and massiveness of the nail folds, disturbed plate growth caused by injury or improper selection of footwear, inadequate care (excessive cutting of nail angles), orthopedic deformations of the foot and postsurgery deformations, overweight (also in pregnant women), excessive sweating and maceration of the skin, and varied growth of the nails and feet during puberty. [6][7][8] The main factor contributing to IN is poorly fitting footwear (including working footwear), which causes biomechanical disturbances between the big toes and other toes when walking. This is most relevant to the lateral edges; therefore, it is suggested that squeezing the lateral nail fold between two toes of the feet causes the development of IN.…”