CAPS original papers
Treatment of ingrown toenails in the pediatric population

https://doi.org/10.1016/j.jpedsurg.2007.12.042Get rights and content

Abstract

Background/Purpose

Nail avulsion plus chemical matrixectomy (CM) using NaOH as an alternative to surgical matrixectomy (SM) has recently been used in the treatment of ingrown toenails (IGTNs) in adults. No studies exist to dictate the most effective and safe treatment method in the pediatric population.

Methods

A retrospective review of pediatric IGTNs treated at 2 institutions for 6 years was done, looking at presentation, treatment modality, SM vs CM, and outcomes.

Results

Eight hundred forty-eight IGTNs in 518 patients were reviewed with an average age of 12.5 years. Twenty-three percent were felt to be infected at the time of presentation, and 34% were being treated with antibiotics within the preceding week of surgery. Seventy-nine percent of toenails underwent surgical management with the most common procedure being avulsion plus SM (65%), followed by avulsion plus CM (17%), and avulsion alone (14%). The overall recurrence rate after initial surgery was 19.5%. After adjusting for covariates, recurrence was associated with treatment by avulsion alone (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.5-4.7), avulsion plus CM (OR, 0.3; 95% CI, 0.1-0.7), and treatment with antibiotics within the week before surgery (OR, 0.5; 95% CI, 0.3-0.9; P = .017). The overall postoperative infection rate was 6% and was unrelated to presence of preoperative infection, use of antibiotics, or surgical treatment method.

Conclusions

Ingrown toenails present a significant problem to youth and should be addressed in a diligent fashion. Chemical matrixectomy using NaOH is a safe and effective alternative to SM and maybe associated with a lower rate of recurrence, especially when use in conjunction with preoperative antibiotics.

Section snippets

Methods

A retrospective chart review was performed on all patients referred to the pediatric general surgery clinic of 2 Canadian pediatric treatment centers, between the ages of 2 and 16 years, between January 1, 2000, and December 31, 2005, for assessment of IGTNs. Only those who ultimately had a surgical procedure by 1 of 6 surgeons were analyzed. Data collected included demographic variables, comorbidities, previous treatment modalities, physical findings at the time of surgery, use of antibiotics

Results

Five hundred eighteen patients with a total of 848 affected IGTNs were analyzed. All were of the great toe. The average age of the patients was 12.5 ± 2.7 (SD) years, and 65% were male. Only a small number of patients had any presenting comorbid conditions (2.5% diabetes, 2.4% developmental delay). The median length of time that the patients had experienced problems with the IGTNs before presentation was 16 weeks; 25% of patients had experienced problems for more than a year.

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Discussion

Ingrown toe nails are a common problem in the pediatric population, especially among adolescents. Decisions to choose one mode of therapy over the other should be guided by clinical presentation, experience, and evidence of what works best.

Conservative treatment of minor cases of IGTNs entails a combination of warm water soaks, topical/oral antibiotics, education about proper nail trimming, and manipulations to separate the corner of the nail from the adjacent soft tissue. In a recent study,

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Presented at the 39th Annual Meeting of the Canadian Association of Pediatric Surgeons, August 23-26, 2007, St John's Newfoundland, Canada.

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