DESTRUCTIVE COMPLICATED ONYCOMYCOSIS WITH NAIL INCARNATION TREATMENT: CLINICAL PRACTICE AND AUTHOR METHODS ANALYSIS

Abstract

Surgical onychopathology includes a group of nail phalanx affections (a nail and periungual tissue infections), that require urgent or planned surgical treatment to exterminate an infection area and to prevent complication and relapse. Researchers have studied some aspects of epidemiology, etiology, pathogenesis of onychopathology, microscopical types of affections, localization, relapse frequency and causes. Still major works are devoted to conservative mycosis treatment.

Aim of research. To study basic methods of complex treatment, improve and implement the author scheme of complex treatment based on analysis of onychomycosis with nail incarnation methods of ingrown nail treatment to optimize early and further results.
Material and methods. Prospective stuff for a 10-year period (2006-2016) includes 496 cases of onychodestructions with nail incarnation: 320 male and 176 female. They were sampled into 17 statistic sub-samples according to methods of surgical treatment, and into 3 sub-excerpts according to basic system antimycotic drugs employment (fluconazole group, terbinafine group and itraconazole group). Age of patients that were surgically treated ranges from 35 to 72 years. All the patients received adequate complex treatment.

Results. In the study it has been statistically proved that system itraconazole therapy, χ2=13,47, р=0,023, in combination with optimized surgical ablation of nails changed by mycosis and terbinafine liniment and antimycotic lacquer local employment permits to achieve 92,3% convalescence from monoonycomycosis including cases with nail incarnation. It has also been proved that optimization of surgical treatment results is possible by means of improvement of incarnated nails surgical treatment with blocklike eponychectomy, some surgery stages succession change, nail plate ablation technics, considering patho- and morphogenetic changes, resection or ablation of nails affected by mycosis through onycholisation, χ2=27,43, р<0,01, with one-stage ablation of dermatophytoma and hyperkeratosis, areas of ingrowth with eponycheal hypergranulation, with one-stage employment of antirelapse measures and partial matrixectomy. Positive effect from combined itraconazole therapy and staged surgical nails extirpation affected by mycosis is proved in 425 cases (85,69%). Based on the analysis of frequency and causes for relapse of onychomycosis and secondary incarnation, it was ascertained that maximum frequency of subungual hyperkeratosis and recurring incarnation relapses are observed (provided that system treatment has not been employed) after 12-15 month. In case of system therapy employment – at the third year. Adjuvant and antirelapse itraconazole system therapy employment alongside with staged surgical operations – purulent area drainage, nail plate extirpation, and antirelapse measures with antimycotic therapy improves effect from complex treatment of complicated and combined onychomycosis from 82,46% to 87,38%.

Diclosures. No conflicts of interest, financial or otherwise, are declared by the authors.

Author contribution. Vergun A.R. and Nadashkevych O.N. drafted manuscript; Parashchuk B.M. and Chulovskyi Ya.B. edited and revised manuscript; Vergun O.M. and Kulchytskyi V.V. approved final version of manuscript.

Author notes. Address for reprint requests and other correspondence: A.R. Vergun, F. Rzhehorzha str. 20, apt. 1 Lviv. Ukraine. CO 79019. (e-mail: plagiamail@meta.ua, plagiapes@gmail.com).