Modified Emmet's operation for ingrown nails using the Er:YAG laser.

BACKGROUND: Ingrowing nails are a common problem. Standard procedure is surgery according to Emmet (a gynecologist) or Emmert (a surgeon) where postoperative pain, swelling and bleeding are major side effects and traumatic damage of the nail organ is not completely avoidable. Laser surgery may provide an alternative with less tissue damage.

METHODS: We compared 138 patients with 212 affected great toe nails (98 males, 40 females) were bloodless Emmet's operation was performed with digital nerve block with 11 patients (12 affected nails) using an Er:YAG laser for atraumatic nail plate removal. Pain was registered by a semiquantitative pain scale (ranging from "zero--no pain" to "10--maximum pain"). Swelling was scored from "0--absent" to "3--severe". Side effects like bleeding, infection or relapse were registered.

RESULTS: Emmet's nail operation: Pain was scored 7.8+/-3.2 on the operation day (evening), 5.3+/-3.1 (day 1) and 3.8+/-4.0 (day 3). Swelling was scored 2.7+/-1.8 (operation day, evening), 2.1+/-1.9 (day 1) and 1.3+/-2.1 (day 3). Wound healing lasted 16.8+/-3.3 days. The infection rate was 2.4%, i.e. 5 of 212 nails. The relapse rate after 6 months was 12 of 212 nails (5.7%). Spicules were observed in 9 of 212 nails (4.2%). Laser procedure: Pain was scored 8.0+/-1.9 (operation day, evening), 4.1+/-1.5 (day 1) and 0.7+/-2.3 (day 3). The swelling was scored 2.4+/-1.8 (operation day, evening), 1.5+/-0.9 (day 1) and 0.9+/-1.3 (day 3). Wound healing was complete after 12.9+/-3.5 days. Infections and relapse were not observed. In one case spicules occurred after 5 months. No other side effects were noted.

CONCLUSIONS: The modified Emmet's operation for ingrown nails using the Er:YAG laser provides a safe method with increased efficacy that causes less pain and swelling, a faster healing and less complications.