Recurrent ingrown big toenails are efficiently treated by CO2 laser.

BACKGROUND

Surgery for onychocryptosis has a high rate of recurrence.

OBJECTIVE

To evaluate CO2 laser partial matricectomy for recurrent onychocryptosis.

METHODS

One hundred ninety-six consecutive patients (predominantly teenagers) previously unsuccessfully treated by surgery underwent CO2 laser for recurrent onychocryptosis. After a digital nerve block and a simple partial nail plate avulsion, the laser was used (5 W, defocused 2 mm beam in continuous mode) to vaporize the matrix, the lateral horn, and the lateral nail groove, including local granulation tissue if present. Follow-up was at least 12 months.

RESULTS

Three hundred forty-four matricectomies were performed. Disease was mostly at stage II and III, with severe local infection in 24 cases (12.2%). All wounds healed in 21.9 +/- 3.2 days, with no postoperative local infection or prolonged exudative drainage. Onychocryptosis reoccurred in 5 of 344 treated margins (1.45%, average 15 months), all after primary bilateral matricectomy. Spicules in the lateral nail groove occurred in 14 of 344 treated margins (4%, average 5.9 months), mostly after primary bilateral matricectomy (7 cases) and in infected margins (8 cases). One patient developed a neuroma in the lateral nail groove.

CONCLUSION

CO2 laser is effective for the treatment of recurrent onychocryptosis. Bilateral matricectomy and local infection seem to be the predisposing factors for recurrence and postoperative spicule growth.