Table 3 Outcome measure: Post-operative complications (infection and haemorrhage) (n = 20)
Author (Year) | Interventions | Outcome | Timepoint | Complication Scores (mean ± SD)* | Significance (p value) |
|---|---|---|---|---|---|
Conservative treatment (e.g., braces and gutter treatment) v’s Chemical matrixectomy (n = 1 study) | |||||
AlGhamdi (2014) [19] | A: Lateral nail avulsion with phenol (n = 30) | Infection | Timepoint unclear | No infections noted in either group | No statistical analysis reported |
B: Nail tube splinting (n = 23) | No infections noted in either group | ||||
Conservative treatment (e.g., braces and gutter treatment) v’s surgical matrixectomy (n = 2 studies) | |||||
Kruijff (2008) [39] | A: Partial nail extraction with partial matrix excision (n = 58) | ‘Post-operative morbidity’ looking at redness, purulent exudate and post-operative bleeding | 1 week | Redness: n = 32 (55.2%) Exudate: n = 10 (17.2%) Post-Operative Bleeding: n = 5 (8.6%) | Redness: p < 0.001 Exudate: p = 0.030 Post-Operative Bleeding: p = 0.060 |
B: Orthonyxia (n = 51) | Redness: n = 5 (9.8%) Exudate: n = 2 (3.9%) Post-Operative Bleeding: n = 0 (0%) | ||||
Peyvandi (2011) [41] | A: Winograd method (n = 50) | Infection | 1 week, 1 month and 6 months (telephone calls and visits) | 1 week: 1 (2%) 1 month: 2 (4%) 6 months: 0 | No statistical analysis reported |
B: Sleeve (gutter) method (n = 50) | 1 week: 1 (2%) 1 month: 3 (6%) 6 months: 0 | ||||
Chemical matrixectomy v’s Surgical matrixectomy (n = 4 studies) | |||||
Leahy (1990) [40] | A: Chemical ablation (phenol) (n = 32) | Infection and haemorrhage | Patients were examined at 1 week, 3 months, and be- tween 16 and 30 months after surgery by an independent observer | Infection: n = 4 Haemorrhage: n = 1 | No statistical analysis reported |
B: Surgical ablation (n = 34) | Infection: n = 3 Haemorrhage: n = 1 | ||||
Bos (2007) [34] | A: Partial avulsion with excision of the matrix, no antibiotics (n = 38) | Infection | 2 days and 1 week | 2 days: Not reported 1 week: 19 of 38 | Antibiotics (A vs B) 2 days: p = 0.989 1 week: p = 0.676 Phenol (C vs D) 2 days: p = 0.224 1 week: p = 0.501 |
B: Partial avulsion with excision of the matrix, with antibiotics (n = 22) | 2 days: Not reported 1 week: 10 of 21 | ||||
C: Partial avulsion with application of phenol, no antibiotics (n = 37) | 2 days: Not reported 1 week: 19 of 33 | ||||
D: Partial avulsion with application of phenol, with antibiotics (n = 26) | 2 days: Not reported 1 week: 13 of 25 | ||||
Korkmaz (2013) [38] | A: Partial matrix excision (n = 17) | Complications including infection | Timepoint unclear | In both groups, none of the patients had postoperative complications | p = 0.688 |
B: Segmental phenolisation (n = 22) | In both groups, none of the patients had postoperative complications | ||||
Muriel-Sánchez (2020) [24] | A: Chemical matrixectomy with phenol (n = 10) | Post-operative bleeding (mild = 1, moderate = 2 and abundant = 3) and infection | The intensity of the bleeding came from the photographic assessment carried out during the first dressing | Bleeding: 1.67 ± 0.58 (95% CI 1.48 to 1.86) Infection: Two incidences | Bleeding: p = 0.910 Infection: p = 0.820 |
B: “Aesthetic reconstruction” (describes partial nail ablation with wedge excision of matrix) (n = 24) | Bleeding: 1.65 ± 0.62 (95% CI 1.51 to 1.79) Infection: Two incidences | ||||
Chemical v’s Other chemical (n = 2 studies) | |||||
Andre (2018) [33] | A: Nail avulsion and phenol (n = 46 toenails) | Oozing (‘present’ or ‘absent’) and Inflammation (‘present’ or ‘absent’ and on a scale of 0–3) | Day 2, 2 and 4 weeks, 4 months | Oozing Day 2: present in 89.4% Week 2: present in 35.1% Week 4: present in 9.4% Month 4: Not present Inflammation Day 2: 28.3% scoring 0, 43.4% scoring 1, 23.9% scoring 2, 4.3% scoring 3 Week 2: 54.3% scoring 0, 34.3% scoring 1, 5.7% scoring 2, 5.7% scoring 3 Week 4: 83.3% scoring 0, 16.7% scoring 1, 0% scoring 2, 0% scoring 3 Month 4: Not present | Oozing Day 2: p = 0.200 Week 2: p < 0.010 Week 4: p < 0.010 Inflammation Day 2: p = 0.340 Week 2: p = 0.520 Week 4: p = 0.030 |
B: Nails avulsion and trichloroacetic acid (n = 50 toenials) | Oozing Day 2: present in 97.8% Week 2: present in 77.8% Week 4: present in 39.4% Month 4: Not present Inflammation Day 2: 17% scoring 0 40.4% scoring 1, 40.4% scoring 2, 2.1% scoring 3 Week 2: 38.9% scoring 0, 47.2% scoring 1, 11.1% scoring 2, 2.8% scoring 3 Week 4: 54.5% scoring 0, 36.4% scoring 1, 3% scoring 2, 6.1% scoring 3 Month 4: Not present | ||||
Ahsan (2019) [42] | A: Chemical matrixectomy with phenol (n = 50) | Infection | Not clear | Present (n = 14) Absent (n = 33) | p = 0.306 |
B: Chemical matrixectomy with trichloroacetic acid (n = 50) | Present (n = 9) Absent (n = 35) | ||||
Chemical timings (n = 1 study) | |||||
Muriel-Sánchez (2021) [25] | A: Partial nail avulsion with 30 s application of phenol (n = 27 halluces [54 nail folds]) | Post-operative bleeding (mild = 1, moderate = 2 and abundant = 3), inflammation (flexible ruler) and infection | The intensity of the bleeding came from the photographic assessment carried out during the first dressing | Bleeding: 1.7 ± 0.5 [CI 95% 1.50 to 1.90] Inflammation: 0.2 ± 0.5 [CI 95% 0.12 to 0.28] Infection: One incidence | Bleeding: p = 0.590 Inflammation: p = 0.470 Infection: p = 0.480 |
B: Partial nail avulsion with 60 s application of phenol (n = 27 halluces [54 nail folds]) | Bleeding: 1.6 ± 0.5 [CI 95% 1.60 to 1.84] Inflammation: 0.3 ± 0.3 [CI 95% 0.18 to 0.42] Infection: One incidence | ||||
Chemical matrixectomy v’s Surgical + chemical matrixectomy (n = 1 study) | |||||
Alvarez-Jimenez (2011) [31] | A: Phenol and curettage (n = 73 nail folds) | Post-operative bleeding (light, moderate or abundant) and infection | Bleeding- 48 h Infection- 1 month | Bleeding: Abundant 30 (42.9%) participants, light/moderate 30 (42.9%) Infection: 2 (2.7%) | Bleeding: p < 0.001 Infection: p = 0.010 |
B: Phenol (n = 79 nail folds) | Bleeding: Abundant 4 (5.4%) participants, light/moderate 70 (94.6%) Infection: 13 (16.5%) | ||||
Chemical matrixectomy v’s ‘Other’ (e.g., laser and electrocautery) (n = 1 study) | |||||
Hamid (2021) [36] | A: Partial nail avulsion and matrixectomy with phenol (n = 50) | Serous and purulent discharge | 4 and 6 weeks | Serous discharge: 2 participants Purulent discharge: 2 participants | Serous discharge: p = 1.00 Purulent discharge: p = 1.00 |
B: Partial nail avulsion and matrixectomy with electrocautery (n = 50) | Serous discharge: 1 participant Purulent discharge: 2 participants | ||||
Surgical matrixectomy v’s Surgical + chemical matrixectomy (n = 1 study) | |||||
Anderson (1990) [32] | A: Nail bed excision (n = 17) | Infection | 2 weeks post-surgery | Seven occurrences | p < 0.010 |
B: Combination of nail bed phenolisation and excision (n = 14) | Two occurrences | ||||
Surgical matrixectomy v’s ‘Other’ (e.g., laser and electrocautery) (n = 2 studies) | |||||
Kim (2015) [44] | A: Curettage (n = 32) | Infection | 3–5 days post procedure | Five (15.6%) occurrences | p = 0.710 |
B: Electrocautery (n = 29) | Three (10.3%) occurrences | ||||
Kavoussi (2020) [22] | A: Partial Nail Matrixectomy using CO2 laser (n = 62) | Infection | Timepoint unclear. Participants were followed over 24 months | Three (4.8%) occurrences | p = 0.485 |
B: Lateral Nail Fold Excision (LNFE) (n = 65) | Two (3.1%) occurrences | ||||
Surgical v’s Surgical (n = 1 study) | |||||
Uygur (2016) [52] | A: Winograd procedure and new suturing technique (n = 64) | Antibiotic administration | Timepoint unclear | Five participants required antibiotics | No statistical analysis provided |
B: Winograd procedure and traditional suturing technique (n = 64) | Nine participants required antibiotics | ||||
Chemical matrixectomy v’s Avulsion only (n = 2 studies) | |||||
Greig (1991) [35] | A: Total avulsion (n = 81 nail edges) | Infection | 2 weeks | No occurrences | No statistical analysis provided |
B: Nail edge excision (n = 56 nail edges) | One (2%) occurrence | ||||
C: Nail edge excision and phenolisation (n = 67 nail edges) | Seven (12%) occurrences | ||||
Khan (2014) [37] | A: Partial Nail Avulsion + Phenol (n = 50) | Infection | 3rd and 7th day | 4% of participants experienced an occurrence | p = 0.029 |
B: Partial Nail Avulsion alone (n = 50) | 12% of participants experienced an occurrence | ||||
Anaesthetics (with and without epinephrine) (n = 1 study) | |||||
Cordoba-Fernandez (2015) [43] | A: Segmental phenolisation matrixectomy with anaesthetic digital block with epinephrine (n = 34 toes) | Bleeding (‘light’, ‘moderate’ and ‘abundant’) | Timepoint unclear | 17.65% (7/36) of toes presenting abundant bleeding | p = 0.001 |
B: Segmental phenolisation matrixectomy with anaesthetic digital block without epinephrine (36 toes) | 94.4% (34/36) of toes presenting abundant bleeding | ||||
Antibiotics (n = 2 studies) | |||||
Reyzelman (2000) [26] | A: 1 week course of oral antibiotics and simultaneous phenol matrixectomy (n = 53) | Infection | Timepoint unclear | Not reported | No significant difference in the prevalence of post procedure infections between groups |
B: 1 week course of oral antibiotics and phenol matrixectomy 1 week later (n = 51) | Not reported | ||||
C: Phenol matrixectomy without antibiotic therapy (n = 50) | 2 post procedure infection | ||||
Bos (2007) [34] | A: Partial avulsion with excision of the matrix, no antibiotics (n = 38) | Infection | 2 days and 1 week | 2 days: Not reported 1 week: 19 of 38 | Antibiotics (A vs B) 2 days: p = 0.989 1 week: p = 0.676 Phenol (C vs D) 2 days: p = 0.224 1 week: p = 0.501 |
B: Partial avulsion with excision of the matrix, with antibiotics (n = 22) | 2 days: Not reported 1 week: 10 of 21 | ||||
C: Partial avulsion with application of phenol, no antibiotics (n = 37) | 2 days: Not reported 1 week: 19 of 33 | ||||
D: Partial avulsion with application of phenol, with antibiotics (n = 26) | 2 days: Not reported 1 week: 13 of 25 | ||||