Videos of Surgical Procedures in Dermatology
Partial Nail Matricectomy with Carbon Dioxide Laser
Matricectomía ungueal parcial con láser de CO2
H.A. Cocunubo-Blanco
, B. González-Sixto, G. Pérez-Paredes, M.Á. Rodríguez-Prieto
Corresponding author
Servicio de Dermatología, Complejo Asistencial Universitario de León, León, Spain
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Cocunubo-Blanco, B. González-Sixto, G. Pérez-Paredes, M.Á. Rodríguez-Prieto" "autores" => array:4 [ 0 => array:4 [ "nombre" => "H.A." "apellidos" => "Cocunubo-Blanco" "email" => array:1 [ 0 => "hacb27@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "B." "apellidos" => "González-Sixto" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Pérez-Paredes" ] 3 => array:2 [ "nombre" => "M.Á." "apellidos" => "Rodríguez-Prieto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Complejo Asistencial Universitario de León, León, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Matricectomía ungueal parcial con láser de CO<span class="elsevierStyleInf">2</span>" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 728 "Ancho" => 951 "Tamanyo" => 90476 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Partial nail matricectomy with carbon dioxide laser.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Onychocryptosis is a very common disorder. It carries a high morbidity due to the associated pain and inflammation that interfere with normal daily activities. Its treatment can be conservative, which often does not achieve the desired result, or surgical, which is more effective as it is designed to eliminate the part of nail matrix that produces the ingrowing nail plate.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> One of the surgical techniques used is partial matricectomy with carbon dioxide (CO<span class="elsevierStyleInf">2</span>) laser, first described in 1980. This technique produces accurate, targeted ablation of the nail matrix.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We describe the case of a middle-aged woman with no past history of interest. She presented longstanding ingrowth of the medial border of the nail of the right great toe. The associated pain limited her mobility and she reported recurrent episodes of inflammation.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Description of the Procedure</span><p id="par0015" class="elsevierStylePara elsevierViewall">Antisepsis is performed with 0.5% chlorhexidine.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The toe is anesthetized by nerve block of the digital nerves, which run laterally, with the injection of 2<span class="elsevierStyleHsp" style=""></span>mL of 2% mepivacaine without epinephrine to each side of the toe. The patient is left for 15 to 20<span class="elsevierStyleHsp" style=""></span>minutes for the anesthesia to take effect.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A tourniquet is applied. The nail fold and the ingrown nail plate are then incised using a CO<span class="elsevierStyleInf">2</span> laser in superpulse mode at 5 watts (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The incised nail fragment is detached and removed with the aid of artery forceps. The area of the nail matrix and nail bed corresponding to the ingrown nail is photocoagulated with the same laser in continuous mode at 2.5 watts.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Two hemostatic sponges are placed on the surgical wound and covered with mupirocin ointment and a sterile gauze dressing.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Finally, it must not be forgotten to remove the tourniquet.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications</span><p id="par0045" class="elsevierStylePara elsevierViewall">This technique is indicated for the treatment of nail deformities such as ingrown nail (onychocryptosis), onychogryphosis, pincer nail, and poor nail alignment.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Contraindications</span><p id="par0050" class="elsevierStylePara elsevierViewall">Absolute: None.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Relative: Peripheral arterial disease and infections.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Benefits</span><p id="par0060" class="elsevierStylePara elsevierViewall">This is a rapid technique with minimal risks and there is little pain or inflammation. The need for sutures is avoided and the technique can be used in patients with pacemakers and those on anticoagulant therapy.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Complications</span><p id="par0065" class="elsevierStylePara elsevierViewall">The complications include wound infection, recurrence, and permanent nail changes due to a poor technique.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Alternatives</span><p id="par0070" class="elsevierStylePara elsevierViewall">Alternative techniques are lateral matricectomy with/without phenolization,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> lateral matricectomy with electrocoagulation, and en bloc excision of the lateral part of nail plate.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0075" class="elsevierStylePara elsevierViewall">CO<span class="elsevierStyleInf">2</span> laser has been widely used for the treatment of dermatological conditions, including alterations of the nail unit. Its use in partial matricectomy provides a rapid technique that is easy to perform and has practically no contraindications. Damage to surrounding tissues is minimal, and there is little bleeding or inflammation. In addition, the antiseptic effect of CO<span class="elsevierStyleInf">2</span>-laser photocoagulation reduces the risk of infection, thus favoring healing and early reinitiation of the patient's usual activities.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The rates of recurrence and of the appearance of spicules reported in the literature are below 7%.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> We therefore consider that partial matricectomy with CO<span class="elsevierStyleInf">2</span> laser is a suitable option for the treatment ingrown nail and that it offers good functional and cosmetic results.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of Interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Description of the Procedure" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Indications" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Contraindications" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Benefits" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Complications" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Alternatives" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Conclusions" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of Interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Cocunubo-Blanco H, González-Sixto B, Pérez-Paredes G, Rodríguez-Prieto M. Matricectomía ungueal parcial con láser de CO<span class="elsevierStyleInf">2</span>. 2014;105:418–419.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0090" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0055" ] ] ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 728 "Ancho" => 951 "Tamanyo" => 90476 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Partial nail matricectomy with carbon dioxide laser.</p>" ] ] 1 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 8322945 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interventions for ingrowing toenails" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 9 | 23 |
| 2024 October | 100 | 50 | 150 |
| 2024 September | 123 | 23 | 146 |
| 2024 August | 143 | 74 | 217 |
| 2024 July | 121 | 46 | 167 |
| 2024 June | 129 | 49 | 178 |
| 2024 May | 109 | 56 | 165 |
| 2024 April | 89 | 32 | 121 |
| 2024 March | 105 | 36 | 141 |
| 2024 February | 76 | 35 | 111 |
| 2024 January | 81 | 41 | 122 |
| 2023 December | 78 | 31 | 109 |
| 2023 November | 78 | 43 | 121 |
| 2023 October | 94 | 32 | 126 |
| 2023 September | 87 | 35 | 122 |
| 2023 August | 58 | 28 | 86 |
| 2023 July | 71 | 45 | 116 |
| 2023 June | 68 | 22 | 90 |
| 2023 May | 77 | 32 | 109 |
| 2023 April | 74 | 20 | 94 |
| 2023 March | 72 | 36 | 108 |
| 2023 February | 64 | 35 | 99 |
| 2023 January | 87 | 41 | 128 |
| 2022 December | 92 | 32 | 124 |
| 2022 November | 75 | 47 | 122 |
| 2022 October | 74 | 36 | 110 |
| 2022 September | 64 | 63 | 127 |
| 2022 August | 69 | 33 | 102 |
| 2022 July | 59 | 44 | 103 |
| 2022 June | 65 | 47 | 112 |
| 2022 May | 57 | 48 | 105 |
| 2022 April | 67 | 55 | 122 |
| 2022 March | 59 | 59 | 118 |
| 2022 February | 45 | 43 | 88 |
| 2022 January | 56 | 60 | 116 |
| 2021 December | 43 | 52 | 95 |
| 2021 November | 54 | 51 | 105 |
| 2021 October | 56 | 60 | 116 |
| 2021 September | 62 | 45 | 107 |
| 2021 August | 51 | 41 | 92 |
| 2021 July | 65 | 45 | 110 |
| 2021 June | 53 | 35 | 88 |
| 2021 May | 89 | 27 | 116 |
| 2021 April | 82 | 53 | 135 |
| 2021 March | 75 | 29 | 104 |
| 2021 February | 72 | 49 | 121 |
| 2021 January | 33 | 32 | 65 |
| 2020 December | 41 | 8 | 49 |
| 2020 November | 28 | 16 | 44 |
| 2020 October | 24 | 11 | 35 |
| 2020 September | 26 | 8 | 34 |
| 2020 August | 36 | 20 | 56 |
| 2020 July | 40 | 7 | 47 |
| 2020 June | 46 | 23 | 69 |
| 2020 May | 33 | 13 | 46 |
| 2020 April | 33 | 11 | 44 |
| 2020 March | 41 | 11 | 52 |
| 2020 February | 3 | 2 | 5 |
| 2020 January | 4 | 4 | 8 |
| 2019 December | 8 | 0 | 8 |
| 2019 November | 4 | 2 | 6 |
| 2019 October | 0 | 4 | 4 |
| 2019 September | 8 | 4 | 12 |
| 2019 August | 2 | 2 | 4 |
| 2019 July | 6 | 2 | 8 |
| 2019 June | 6 | 17 | 23 |
| 2019 May | 4 | 16 | 20 |
| 2019 April | 2 | 3 | 5 |
| 2019 March | 2 | 7 | 9 |
| 2019 February | 4 | 0 | 4 |
| 2019 January | 2 | 0 | 2 |
| 2018 December | 4 | 0 | 4 |
| 2018 November | 1 | 0 | 1 |
| 2018 October | 6 | 0 | 6 |
| 2018 September | 46 | 0 | 46 |
| 2018 April | 0 | 4 | 4 |
| 2018 March | 0 | 4 | 4 |
| 2018 February | 34 | 5 | 39 |
| 2018 January | 47 | 12 | 59 |
| 2017 December | 62 | 17 | 79 |
| 2017 November | 90 | 9 | 99 |
| 2017 October | 39 | 8 | 47 |
| 2017 September | 53 | 9 | 62 |
| 2017 August | 100 | 10 | 110 |
| 2017 July | 68 | 14 | 82 |
| 2017 June | 89 | 32 | 121 |
| 2017 May | 80 | 23 | 103 |
| 2017 April | 103 | 22 | 125 |
| 2017 March | 58 | 8 | 66 |
| 2017 February | 39 | 19 | 58 |
| 2017 January | 34 | 15 | 49 |
| 2016 December | 56 | 25 | 81 |
| 2016 November | 59 | 16 | 75 |
| 2016 October | 81 | 18 | 99 |
| 2016 September | 78 | 14 | 92 |
| 2016 August | 67 | 16 | 83 |
| 2016 July | 52 | 10 | 62 |
| 2016 June | 9 | 9 | 18 |
| 2016 May | 9 | 15 | 24 |
| 2016 April | 5 | 21 | 26 |
| 2016 March | 2 | 17 | 19 |
| 2016 February | 10 | 1 | 11 |
| 2016 January | 4 | 1 | 5 |
| 2015 December | 5 | 2 | 7 |
| 2015 November | 2 | 4 | 6 |
| 2015 October | 4 | 2 | 6 |
| 2015 September | 4 | 8 | 12 |
| 2015 August | 3 | 1 | 4 |
| 2015 July | 38 | 1 | 39 |
| 2015 June | 36 | 8 | 44 |
| 2015 May | 39 | 16 | 55 |
| 2015 April | 20 | 17 | 37 |
| 2015 March | 26 | 12 | 38 |
| 2015 February | 12 | 6 | 18 |
| 2015 January | 54 | 7 | 61 |
| 2014 December | 64 | 9 | 73 |
| 2014 November | 20 | 4 | 24 |
| 2014 October | 25 | 4 | 29 |
| 2014 September | 14 | 2 | 16 |
| 2014 August | 19 | 7 | 26 |
| 2014 July | 26 | 5 | 31 |
| 2014 June | 47 | 13 | 60 |
| 2014 May | 101 | 9 | 110 |
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