Treatment of Ingrown Toenail With Proximolateral Matrix Partial Excision and Matrix Phenolization

We have read the article of or colleagues Karaca and Dereli with great interest.1 They showed that proximolateral matrix partial excision in combination with matrix phenolization is a suitable surgical intervention for treating ingrown toenails in family practice. In the recently updated Cochrane review on interventions for ingrowing toenails this surgical treatment combined with the application of phenol also shows to be one of the most effective treatments.2 .

We only found one randomized controlled trial in which a surgical intervention known as partial nail avulsion with matrix excision was compared with the same surgical intervention with phenol. In this study of 117 participants, the surgical intervention with phenol was significantly more effective in preventing recurrence than the surgical intervention alone (14% compared to 41% respectively, RR 0.34, 95% CI 0.17 to 0.69).

In the Cochrane Review we addressed some gaps in the knowledge about the treatment of ingrowing toenails. New trials are needed to determine the place of non-surgical interventions in the treatment of stage I and II ingrowing toenails. New trials are also needed to determine if the addition of chemical ablation to a surgical procedure gives a reduction of the risk of recurrence compared to the surgical procedure alone. Furthermore, new trials should also examine relevant, uniform short-term outcomes, such as healing time as an objective measurement and participant satisfaction as a subjective measurement, in addition to the primary outcome of recurrence or regrowth.

We have a problem with the numbers of patients in table 1 about patient characteristics. In all 348 ingrown toenails in 225 patients were treated. In the table is given that 42 were bilateral and 264 were unilateral (264 + 42 + 42=348 toes) and a sum of 306 (284+42) patients. How do the authors explain this?

Unfortunately the study of Karaca and Dereli does not answer any of these questions, as they did not include a control group. It is well known that case series such as these are subject to a number of potential additional biases that may threaten their external validity. For example, were all eligible patients included in the study and was complete follow-up obtained from all?

We hope that new well designed studies will answer the outstanding issues in the treatment of ingrowing toenails.

references

Karaca N, Dereli T. Treatment of ingrown toenail with proximolateral matrix partial excision and matrix phenolization. Ann Fam Med 2012: 10 (6), 556-9.

Eekhof JAH, Van Wijk B, Knuistingh Neven A, van der Wouden JC. Interventions for ingrowing toenails. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD001541.

Competing interests:   None declared