Malka Marcin, Kowalska Kinga, Gójska Joanna

1. CHRONIC WOUND OF THE
LATERAL NAIL FOLD –
THE HOLISTIC APPROACH
Marcin Malka, Joanna Gójska, Kinga Kowalska
PODOS Wound Care Clinic, Poland
The purpose of the presentation is
to present modern approach in
chronic wound of the lateral nail
fold treatment to the wide group of
wound care specialists.
The problem of ingrowing nail and
chronic wound which often occurs
together affects many people,
especially young ones. In Poland the
standard surgeon procedure nowadays
is wedge resection with nail bad.
Recurrence rates vary in the literature
reflecting different levels of
experience. According to our
observations that kind of treatment
causes many relapses. Due to mutual,
holistic approach of the surgeon and
the podologist we were able to make
minimally invasive method and among
our patients without any relapse.

2. The treatment is divided into two
stages. In the first stage a
hypertrophic lateral nail fold tissue
is surgery removed to revile nail
plate.
Unlike many popular and often
used methods during the treatment
we do not remove the nail plate and
nail bad or matrix but only
outgrown nail fold with wound.
Such a completely different method
of treatment was elaborated due to
cooperation of surgeon and
podologist.
It is necessary to equip a standard
treatment room with podologist
probe in order to treat efficiently.
Dressings used during the
treatment: non-absorbent net with
silver, hydrofiber and adhesive
foam.
The treatment (surgery) is done
with anesthetic and Oberst method.
After cleaning, wrapping the field
of treatment and clamping rubber
band at the toe base, we lift lateral
nail fold with forceps and cut off
with scalpel in such a way that lay
open entirely edge of the nail plate.

3. Podologist probe is evaluated
whether the edge of the nail plate is
even. If not we correct it using a
nipper. We use the antiseptic
according to local protocol. The
other stage of treatment (around 4-
5 visits every 3-4 days) is wound
healing which occurred after
removing that wound by using
tamponads between nail plate and
lateral nail fold. Tamponads are
made of modern dressings and can
consist as silver and hydrofiber.
Adhesive foam is the second
dressing. That stage is over when
wound is covered by epidermis.

4. The next visits are conducted by
podologist, who make nail plate and
puts buckle. The buckle is made
from steel wire. The wire is applied
over the dorsal surface of the nail
and hooked under its lateral edges.
Establishment of smaller and smaller
buckles causing straightening of the
curvature of the nail. There is
tolerance test control after one week
of first using of buckle. During other
visits (once a month) patient has got
a new tool. The number of visits
depends on nail plate healing and the
kind of buckle used. After
approximately 8 months the nail
plate has got correct shape. The
treatment is over and patient is
informed how to minimalize the risk
of relapse.
Result: Results in tested group are
very satisfying. All our patients are
healed. There were no interference
into nail bad among none of them.

5. Conclusion: Holistic approach in
treatment of the chronic wound is a
standard procedure. Treating lateral
nail fold wound which lasts more
than 8 weeks as a chronic one we
have to use the same and universal
methods like in the another kind of
wound. Close coordination of
surgeon and podologist enables the
using not much invasive and
effective method.
This encourages us to share with
You our expirences.
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