PURULENT NECROTIC AND COMBINED CHRONIC PATHOLOGY OF THE HAND AND FOOT DISTAL AREAS (SURGICAL ONYCHOPATHOLOGY, SURGICAL NAIL PATHOLOGY): SOME ASPECTS OF COMPLEX TREATMENT

Abstract

The article presented the results of the study of purulent-necrotic chronic and combined pathology of the distal parts of the hand and foot in the context of analysis of lesions of the distal nail phalanges of the fingers (surgical onychopathology). Nosological forms, some clinical features, complications are stated, generally accepted and author’s views on complex treatment are presented and substantiated. The need for complex research of chronic surgical onychopathology is primarily determined by a significant of uncomplicated and complicated cases, especially recurrent cases. In the specialized professional literature are a significant publications on the nail plate pathology, but the surgical aspects of the distal (nail) phalanx pathology allotted a minimal, secondary role. The aim of the work was to optimize the schemes of complex treatment and surgical interventions of some chronic destructive purulent pathology of the distal parts of the hand and foot, (onychopathology), when ascertaining of some combined cases associated with onychomycosis. For a 15-year period (2006–2020) some cases of chronic purulent-necrotic processes in 1838 patients aged 5–92 years: 1007 men and 831 women, uncomplicated, complicated and combined lesions were studied. Imperfection of surgical techniques determined for more than half of the causes of recurrence, including cases of ingrowth with complicated subungual hyperkeratosis or onychogryphosis, χ2=20,13; p<0,01. Be claimed that the most formidable complication of superficial chronic purulent-necrotic lesions is phalanx osteomyelitis, bone panaricium (panaritium osseare or osteo-articulare), pandactylitis, some clinical diagnostic criteria and principles of treatment are formulated. Precision necrectomy promotes the purulent-inflammatory process elimination. Low-traumatic nail removal or nails resection through onycholized structures by transeponycheal incision (block eponychectomy) determines a statistically significant increase in wound healing rate, Popova index etc (χ2=32.14, p<0.01), the decrease in intraoperative nail phalanx trauma (χ2=20.13, p<0,01), reduces the risk of other fungal contamination (χ2=27.41, p<0,01), is characterized by decrease of a pain intensity (χ2=48.32, p<0,01, Spearman’s ratio (ρ) 0,624–0,692 depending on the analyzed factor), these nuances determines the positive dynamics and improvement of the quality of life of patients.