New strategy for the treatment and assessment of pincer nail

A novel surgical method for repair of pincer nail deformity with excessive transverse curvature of the nail plate is presented. Surgical procedures are as follows. First, after the gentle removal of the nail plate, a skin incision was produced exhibiting a fishmouth pattern in which a dorsally convex triangular flap was maintained at the toe tip. The nail bed flap was elevated at the level immediately above the lateral interosseous ligaments. Second, the dorsal osteophyte of the distal phalanges was resected and flattened with a bone rongeur. Third, the flap margin containing the contracted hyponychium was cut into three portions to facilitate nail bed widening in the transverse direction. Fourth, flap margins were trimmed into four flaps; in addition, the corresponding skin margin was trimmed in a similar manner. In particular, the area corresponding to the lateral wall of the nail was denuded to serve as a base for the lateral wall of the nail bed to maintain the transverse widening. Finally, the nail bed flap was positioned and sutured in a zigzag fashion. Postoperatively, no conspicuous scars or complications were apparent in 27 patients (40 toenails). This novel procedure is suitable in instances involving severe deformities of the nail. Two original indices (width index and height index) are also indicated in the quantitative assessment of the degree of pincer nail deformities.