A New Surgical Technique in Treatment of Nail Onycogryphosis

Onychogryphosis is an extreme form of irregular, distorted, thickened, hard and discolored, yellow to brown nails on a hyperkeratotic, hyperplastic and onycholytic nail bed usually in the great toe nails of the elderly and infirms. The hypertrophic, twisted and discolored nail plate is shaped like a ram`s horn. Onychogryphosis may rarely occur as a developmental abnormality in young and middle aged and is transmitted as an autosomal dominant trait. Other causes are: ichthyosis, psoriasis, onychomycosis, foot anomaly such as hallux valgus. Treatment of onychogryphosis is either radical or palliative.1,2 Conservative management is especially useful in feet, at high risk patients with peripheral vascular disease and diabetes. Radical treatment consists of surgical removal of the nail and matricectomy by phenolization, Co2 laser, etc.3 We decided to repair the onychogryphotic toe nail to nearly normal shape by a unique treatment by combination of partial nail matrix phenolization, nail bed widening by longitudinal cuts in the nail bed, onycholysis treatment and displacing the nail matrix and nail bed to opposite direction of nail deviation.