INGROWING TOE-NAIL.
The cause of this condition should be avoided; it consists in the habit of paring the nail squarely so as to leave a sharp angle under the skin edge, which is forced into the skin by the pressure of a tight boot with a narrow, tapering or schooner-shaped toe.
In trivia] cases the clipping of the free margin of the nail, so as to leave the angle of nail projecting beyond the skin, and scraping of the dorsal surface with the edge of a bit of glass or with the knife so as to reduce its thickness and to produce a tendency to curling upwards or backwards of its lateral margins, and the removal of any cuticle accumu lated under the ingrowing edges of the nail, are all that are required to give relief and prevent further progress of the condition.
If ulceration has already occurred a minute roll of gauze or of tinfoil should be neatly packed down between the tender overhanging skin and ingrowing edge so as to insinuate itself under this edge and cause eleva tion of it. Strapping should he then applied, so as to retain the roll in its position and at the same time to drag upon the overhanging integu ment and keep it pulled away from contact with the ingrowing edge. In a short time the roll of tinfoil can be easily packed well under the inturned edge, so as to secure its thorough elevation; it should not he removed for several days, after which the space may be filled with Iloracic Acid, Nitrate of Lead, Alum, Oxide of Zinc, or with the following— It PitIv. loeloforini 3iv.
Calamina' Pneparat. 3ij. Misce.
Nitrate of Silver, Sulphate of Copper, strong Solution of Perchloride of Iron, pure Carbolic Acid, and Acid Nitrate of Mercury are useful for the destruction of exuberant granulations, and occasionally they destroy the sharp inner edge of the nail which is beyond the reach of thy knife and scissors, but mere paring of this margin of the nail is useless. Pfirchauer softens the nail by several applications of a 4o per cent. solution of Caustic Potash, scraping its surface after each application till the nail becomes a mere film in thickness, after which it may he lifted up with forceps and cut as easily as paper.
When the ulceration does not disappear, under cocaine or ether spray the overhanging granulations and integument may be shaved clean off by means of a sharp scalpel and the wound left to heal under antiseptic dressings. If Cotting's modification of this method be pursued excellent results are obtainable; he extends the incision backwards so as to remove all granulating tissue together with a slice from the side of the toe, taking care, however, not to interfere with the inner margin of the nail. This method, if skilfully performed, often gives better and more lasting results than those following the operation of avulsion.
A more radical operation is to carry the incision through the nail, removing a considerable longitudinal strip of it, and then to excise com pletely the matrix belonging to the portion of nail removed, and the overhanging skin.
Where the ulceration process has loosened the entire nail avulsion is necessary. This is accomplished, when the patient is fully under the influence of an anmsthetic or under local anwsthesia, by inserting one blade of a pair of dressing forceps under the centre of the nail to its root and securing a firm grip as the blades are closed, and by firm traction the nail is removed.
One-half of the nail may be removed, after previously cutting it in two, lay inserting one blade of a pair of fine and sharp-pointed scissors under its centre and pushing it down to the root. The loosened portion may then be easily removed by the forceps. Powdered Boracic Acid being freely applied, the wound may be enveloped in lint moistened with Spirit Lotion and surrounded with oiled silk. Should trouble arise after the growth of the new nail the entire matrix must be dissected out after a second avulsion has been performed.