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Hello,
Doing a lit. review on recurrence incidences following PNA nail avulsion with phenol. (Ross procedure). The aim is to find an evidence-based benchmark for our audit of regrowth after surgery with phenol. Stuck on something I can't find answer to: Aetiological factors of ingrowing toenail are well known. Research papers and the Cochrane review by Rounding and Bloomfield (2005) refer to recurrence symptomatic and asymptomatic. The follow-up period in the studies varies. The papers I have read generally define recurrence as piercing of the nailfold and/or nail spicules. I get that nail spicules are a reliant indicator for phenol application failure. My query is in studies were they have found piercing of the nailfold a year + later: How does the researcher/ reader know that this is down to the surgery/aftercare and not a new ingrowing toenail caused by underlying aetiological factors, for example hyperhidrosis, gait that were the culprit first time round.

In summary is it possible that the very high incidences of recurrence, 24.13% of nail edges (7 nail edges) ( Gerritsma-Bleeker et al. 2002. Partial Matrix Excision or Segmental Phenolization for Ingrowing Toenails) could actually be partially explained by a new ingrowing toenail rather than surgery techniques. How can you tell? What follow-up period is most appropriate for measuring purely the outcome of the surgery.

Does anyone have any lit. sources or articles on this or does my query contain a major flaw which resolves the matter?

Thank you.

 

Gosh- you came prepared. Awesome.
The trouble with this scenario is, it is a chicken and egg situation. Plus it leads into so many tangents- eg: if the regrowth is pain free and incident free- is that not a successful outcome?
Good luck on your queries.

 

Thank you for your message Tree Harris.

Judging from the lack of responses I can only concur with what you said about the chicken and egg. It would seem that the only way to conduct an audit is to focus on patient-relevant painfree success rates.