The Treatment of Ingrown Nail: Chemical Matricectomy With Phenol Versus Aesthetic Reconstruction. A Single Blinded Randomized Clinical Trial

Abstract

Background: In onychocryptosis surgery, incisional and non-incisional matricectomy is indicated according to the stage. The chemical matricectomy with 88% phenol solution is the gold standard and a wedge resection is indicated for more advanced stages. The aesthetic reconstruction has the advantages of the incisional procedure without eponychium incisions and an effectiveness similar to the chemical matricectomy with phenol. Objective: To compare the recurrence and the healing time between the chemical matricectomy with phenol and the aesthetic reconstruction. Methods: A comparative, prospective, parallel, randomized, and one-blinded clinical trial was registered with the European Clinical Trials Database (EudraCT) with identification number 2019-001294-80. Thrity-four patients (56 feet) with 112 onychocryptosis were randomized in two groups. Thirty-six were treated with chemical matricectomy with phenol and 76 with aesthetic reconstruction. Each patient was blind to the surgical procedure assigned by the investigator. The primary outcome measurements were healing time and recurrence. The secondary outcome measurements were post-surgical bleeding, pain, inflammation, and infection rate. Results: The aesthetic reconstruction procedure presents a shorter healing time (8.2 ± 1.4 days vs. 21.3 ± 3.1 days; p < 0.001) with a similar recurrence rate (p = 0.98). Post-operatory bleeding, pain, inflammation, and the infection rate did not show significant differences (p > 0.05). Conclusions: The aesthetic reconstruction presents a shorter healing time, favoring the patients’ recuperation, with a recurrence similar to the chemical matricectomy with 88% phenol solution.

Effect of Phenol Application Time in the Treatment of Onychocryptosis: A Randomized Double-Blind Clinical Trial

“…It must be taken into account that the procedures were carried out under conditions of ischemia. In line with another clinical trial, we did not obtain significant differences for the bleeding indicator [ 19 ], differing from other studies where the bleeding was greater after removing the cauterized tissue with a curettage [ 2 ]. Recently, other authors have reported platelet-rich fibrin, rather than nitrofurazone, in conjunction with chemical matricectomy performed with 1-min of 88% phenol solution reduced bleeding after nail surgery [ 11 ].…”

“…Álvarez et al (2012) performed a study to examine the effect of curettage on healing time, and they obtained that curettage after segmental phenolization reduced healing time [ 2 ]. Recently, a clinical trial, the aim of which was to compare the chemical matricectomy with phenol and the aesthetic reconstruction, reported a healing time of 21.3 days using a 88% phenol solution with 60 s application [ 19 ].…”

“…In line with this, Pérez-Rey et al (2014) obtained a recurrence rate of 1.1% for NaOH chemical matricectomy during 30 s [ 34 ]. Recently, a clinical trial has reported 2.8% to chemical matricectomy with a 1-min phenol application [ 19 ].…”

“…Some authors have suggested that phenol may reduce postoperative pain as a result of neurolytic effect, but only a few studies have analyzed this variable using pain scales [ 2 , 19 , 22 , 29 ]. Post-surgical pain was greater after 24/48/72 h for the experimental group.…”

“…The primary outcome measurements were healing time. The healing time was measured as previously described criteria [ 2 , 18 , 19 ], considering the period of time between ending surgical procedure and resolution of the postoperative period. These criteria were absence of exudate at gauze; formation of scab covering the wound; the wound must be kept uncovered; no signs of infection or inflammation at nail folds; no signs of erythema or hypergranulation tissue ( Figure 3 ).…”