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Research Letter |

A Conservative Method to Gutter Splint Ingrown Toenails ONLINE FIRST

Arash Taheri, MD1; Parisa Mansoori, MD2; Hossein Alinia, MD1; Robin Lewallen, MD1; Steven R. Feldman, MD, PhD1,2,3
[+] Author Affiliations
1Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
2Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina
3Department of Health Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
JAMA Dermatol. Published online September 03, 2014. doi:10.1001/jamadermatol.2014.1757
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Ingrown toenails can be due to trauma, improper nail cutting, and/or anatomic abnormalities of the nail apparatus. In the setting of normal anatomy, they are usually treated conservatively, but the presence of a sharp edge of the nail in the ulcer may prevent wound healing. Isolation of the nail plate from the ulcer bed using a gutter-shaped splint may improve healing.1,2 In the classic gutter splint method, the ingrown edge of the nail plate is freed up to the extreme proximal part and then splinted using a gutter. This method requires anesthesia.35 Herein, we describe a more conservative gutter technique that is less traumatic and does not require anesthesia.

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Figure 1.
An Ingrown Toenail Splinted Using a Flexible Tube (A) and Cyanoacrylate Glue (B)

A, An ingrown toenail splinted using a fine flexible tube. B, The tube was secured using cyanoacrylate glue. The patient was very satisfied with cosmetic appearance and stability of the splint.

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Figure 2.
Flow Diagram of the Patients’ Progress Through the Study

The asterisk marks the 11 patients who completed a median of 3 months’ follow-up (range, 2-7 months) after complete healing. Two patients experienced recurrence after complete healing and removal of the gutter. Both of these patients reported that ill-fitting shoes or trauma was the cause of their recurrence, and both asked for the same gutter procedure without anesthesia to be performed for them again.

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