Mitchell S, Jackson C R, Wilson-Storey D
Department of Paediatric Surgery, Royal Hospital for Sick Children, Edinburgh, UK.
Ann R Coll Surg Engl. 2011 Mar;93(2):99-102. doi: 10.1308/003588411X12851639107674. Epub 2010 Nov 12.
Surgery for ingrowing toenails carries a significant re-operation rate. We reviewed our departmental figures to assess the optimal management of these patients.
We performed a 10-year retrospective review of all patients undergoing surgery for ingrown toenails (IGTN) in order to determine the operations most commonly used and the re-operation rate of each of these procedures.
A total of 880 procedures were performed on 414 patients. The median age at operation was 8.5 years. About half (48%) of children underwent two or more procedures with wedge excision and phenol application being the most common initial and repeat procedure. Recurrent surgery was most likely following plain avulsion or wedge avulsion without phenol application. Excision of the nailbed with phenol application had the lowest recurrence rate at 18.4%.
We recommend wedge resection with phenol application as first-line treatment with simple avulsion reserved for severely infected toes. Total nail bed excisions should be reserved for patients with significant on-going morbidity associated with IGTN. Families must be made aware of the likely outcome of IGTN surgery and the choice of operation must be tailored to the individual.
嵌甲手术的再次手术率较高。我们回顾了本部门的数据，以评估这些患者的最佳治疗方法。
我们对所有接受嵌甲手术的患者进行了为期10年的回顾性研究，以确定最常用的手术方法以及每种手术的再次手术率。
共对414例患者进行了880次手术。手术时的中位年龄为8.5岁。约一半（48%）的儿童接受了两次或更多次手术，楔形切除加苯酚涂抹是最常见的初次和再次手术方法。单纯撕脱或楔形撕脱且未涂抹苯酚后再次手术的可能性最大。苯酚涂抹下的甲床切除术复发率最低，为18.4%。
我们建议将楔形切除加苯酚涂抹作为一线治疗方法，单纯撕脱仅用于严重感染的脚趾。全甲床切除术应保留给与嵌甲相关的持续严重发病的患者。必须让家属了解嵌甲手术的可能结果，并且手术选择必须因人而异。
