Nail wedge excision

from Wikipedia, the free encyclopedia
Photo approx. 2 weeks after the operation
Condition after months ago Emmert sculpture of the left Big toenail, left side. The slight narrowing is practically invisible and depends on the surgeon.

The Nagelkeilexzision also Emmert plastic is a medical treatment method in Unguis incarnatus (ingrown nail) is applied.

A wedge-shaped piece of the affected toenail or fingernail, together with the associated part of the nail bed and the nail matrix, is removed under ( supreme) conduction anesthesia . If the nail matrix is ​​not removed, the nail will grow back unchanged. To do this, the skin is incised parallel to the long side of the nail and a tissue wedge with the ingrown nail is removed down to the bone. The wound is then only adapted, not sutured tight. The wound usually heals without further measures under a sterile bandage with PVJ ointment (iodine ointment). It should be said that microbiologists have not approved of PVJ ointments since the 1990s, as the iodine prevents the growth of the granulation tissue and there is no deep antimicrobial effect, especially on the bones. This is only safer with antibiotics .

Photo approx. 2 months after the operation

This procedure reduces the size of the nail bed , among other things , so that the toenail then grows back in a narrower shape and thus no longer cuts the side of the nail wall. Complete healing takes about two to four weeks. During this time, the front part of the foot should be moved as little as possible. This can e.g. B. can be achieved by a so-called bandage shoe with a stiff outsole. This means that the operated person is also mobile.

During the operation, the nail must be narrowed down to its proximal (close to the body) attachment. This approach is called the nail matrix . If only a small part of it remains in the original width, this leads to problems such as wound healing disorders, fistulas or nail parts that grow back under the skin. With careful surgery, a high relapse rate is avoided. An alternative is the combination of Emmert and Vandenbos plastic. This combination can restore a natural relationship between the width of the nail and the width of the big toe.

Nail correction braces also known as orthonyxis braces, possibly as an alternative to Emmert plastic

In some cases the operation can be avoided with a nail correction brace ( orthonyxis brace ).

Individual evidence

  1. ↑ Stefan Rammelt, René Grass, Hans Zwipp: For the treatment of the ingrown toenail. What is an “Emmert plastic”? In: The surgeon . tape 74 , no. 3 . Springer, 2003, ISSN  0009-4722 , p. 239–243 , doi : 10.1007 / s00104-002-0593-3 .
  2. ↑ Jörg Carls, Ludger Kirsch: Wundantiseptika - Kaliseife gegen Iodophor: A comparison . In: Orthopedic Practice . tape 39 , no. December 12 , 2003, ISSN  0030-588X , p. 762-766 .
  3. ↑ Jörg Carls, Nikolaus Wülker: Therapy of wound infections on the forefoot . In: Orthopedic Practice . tape 34 , no. 4 , April 1998, ISSN  0030-588X , p. 244-248 .
  4. ↑ KQ Vandenbos, WP Bowers: Ingrown toenail: a result of weight bearing on soft tissue . In: US Armed Forces Med J . tape 10 , no. 10 , 1959, pp. 1168-1173 .