Complicated Onychomycosis with Nail Incarnation: Pathogenetic Submission of Less Traumatic Nail Extirpation and Some Peculiarities of Complex Treatment

The morphogenesis of the nail secondary incarnations was studied and the results of the onychomycosis treatment were improved by introducing pathogenetically proposed using pedicure tools non traumatic removal of the nail plate of destructive mycotic nail extirpation and subnail hyperkeratosis and onychogryphosis, complicated by nail ingrowth through onycholized structures. Material and methods. The study of nosological forms and clinical variants of surgical onychopathology from the organizational problems of diagnosis and complex treatment, the results of retro and prospective analysis for the 10-year period of medical cards of 503 men and 416 women, prevention of complications (including generalized) and relapses. Patient examination and treatment was performed in accordance with all requirements of Recommendation of Good Clinical Practice from 1996, and the Order of Ministry of Health of Ukraine dated 23.09.2009. All participants received informed consent and we taken all measures to ensure anonymity of patients. The article uses the materials of Vergun A.R. MD dissertation; other authors have substantiated and implemented the results in clinical practice without a scientific and legally significant conflict of interests. The trustee interval was 95%, for the analysis of quantitative values, the Pearson's method and for qualitative - Spearman's method was used, χ2 was determined by the degree of influence of individual factors, correlation between nosological forms, morphogenesis, clinical manifestations and the effectiveness of complex treatment. Results and discussion. The analysis of subungual structures at onychomycotic lesions with secondary incarnation of the nail allowed to state the predominance of dermatophytes (red trichophytes) (χ2 = 35.43, p <0.01) and other pathogens and bacterial flora in one third of patients. The presence of hyperkeratosis and onycholysis, which leads to the detachment of a part of the nail plate (32.54% of the total sample) was confirmed, which in our opinion substantiates the performance of the low traumatic onychoectomy with the simultaneous removal of dermatophytoma and ingrouth structures, which determines the reduction of injury to the unaffected areas of the nail bed (χ2 = 20.13, p <0.01), small contamination of periungual structures, (χ2 = 27.41, p <0.01). Operative treatment with partial marginal matrixectomy (χ2 = 18.21, p <0.01) prevents complications and compression relapses.