F. R. ZADIK, SHEFFIELD, ENGLAND
From the Wharncliffe Hospital, Sheffield
Ingrowing toe nail and onychogryphosis arising from deformity of the nail bed of the
great toe often give rise to much disability, and although many treatments have been used none is entirely satisfactory. Conservative measures such as thinning the nail and cutting a longitudinal groove may control the ingrowing, and repeated filing may suffice for onychogryphosis, but such treatment must be continued indefinitely. Repeated avulsion seldom gives permanent cure, and excision of a wedge from the lateral border causes persistent deformity of the nail. Removal of the whole nail bed together with excision of the distal half of the terminal phalanx is often satisfactory but the cosmetic result is poor; the wife of one of my friends who was so treated described her great toes as “two funny little dumplings.” Complete excision of the nail bed with mobilisation and suture of the proximal and distal flaps (Nuttall 1941) failed in three cases because tension caused necrosis of the flaps so that the wounds broke down. Moreover excision of the nail bed with skin grafting of the raw area is uncertain.