Clin Orthop Surg.  2018 Sep;10(3):385-388. 10.4055/cios.2018.10.3.385.

Nail Plate and Bed Reconstruction for Pincer Nail Deformity

• Shin WJ
• Chang BK
• Shim JW
• Park JS
• Kwon HJ
• Kim GL

• KMID: 2418761
• DOI: http://doi.org/10.4055/cios.2018.10.3.385

Abstract

Pincer nail deformity is a severe condition in which the nail bed becomes compressed and the nail shows an overcurvature. We retrospectively analyzed 13 pincer nail deformities treated using our nail plate and bed reconstruction technique. Visual analogue scale scores, the width of nail root, width of nail tip, height of nail tip, width index, and height index were assessed before and after surgery. The overcurvature was corrected after detachment of the nail plate. The nail fold was pushed underneath the nail plate and then fixed. The width of nail tip significantly increased after surgery (p < 0.05) and was maintained during follow-up. The height of nail tip decreased after surgery (p < 0.05). This nail plate and bed reconstruction technique is a simple and quick surgical method for correcting deformities and reduces risks of complications such as skin necrosis and infection compared to other existing surgical techniques. We recommend this efficient surgical technique for the treatment of pincer nails.

Keyword

Nails; Pincer nail; Nail abnormality; Nail reconstruction

MeSH Terms

Congenital Abnormalities*
Follow-Up Studies
Methods
Nails, Malformed
Necrosis
Retrospective Studies
Skin

Figure

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  Fig. 1 Illustration of nail measurements. A: width of the nail root. B: width of the nail tip. C: height of the nail tip. Width index = B/A × 100. Height index = C/B × 100.

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  Fig. 2 Illustration of nail bending technique and nail bed fixation. (A) The nail plate is bent to detach periosteum at the point of the maximal curve. (B) The nail fold is placed and fixed underneath the lifted nail bed to act as a buttress. Curved arrow: nail plate. White arrow: nail bed.

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  Fig. 3 Nail plate and bed reconstruction technique. (A) Preoperative photograph. (B) A 5-mm bilateral oblique incision is made in the proximal area of the nail fold. (C) We used the Kelly to bend the nail at the highest point of the curve. (D) The nail bed is gently detached from the distal phalangeal bone using a sharp #11 blade. (E) The inflammatory lesion in the nail fold is identified and removed. (F) The germinal matrix is gently ablated. (G) The nail bed under the nail plate is sutured with 3-0 or 4-0 nylon. (H) Postoperative photograph.

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