Onychocryptosis is a frequent demand in dermatological assistance, and its surgical management requires both specific training and indication criteria.

Currently, there is no consensus or body of evidence on the specific differences between the surgical techniques for onychocryptosis or their comparison in terms of effectiveness, morbidity, infection, cost-effectiveness and technical difficulty. Thus, developing new methods is of scientific relevance and should be encouraged considering the described surgeries, especially regarding the technical differences and recurrence rates after 12 months.

Dr Ma has proposed a surgical technique sequence with interesting results, which is very similar to the classic matricectomy described by Winograd (1929), which has undergone several adaptations over the years. Moreover, the Winograd method or its variants has shown an expected recurrence rate of approximately 6% in virtually all studies. As this is a similar surgical approach, the result shown by Ma, who found no recurrence in 67 surgeries (with a follow-up of 6-12 months), may not represent a difference concerning the expected rate of 6% due to the modest sample size. Yet, it can also be due to the small percentage of cases with grade I onychocryptosis, which usually do not show recurrence and whose frequency was not determined by the author.

Surgical techniques for treating onychocryptosis demand careful systematization of the operative sequences and approach to the matrix and the precise indication according to tissue hyperplasia, nail plate situation and pyogenic granuloma. Only the comparative analysis of the performance of the techniques, stratified according to the indications, can attract criticism, ultimately maximizing the performance of the procedures.

The peculiar anatomy of the nail apparatus demands surgical approaches by specially trained dermatologists. Yet, despite the high prevalence of onychocryptosis and its impact on quality of life, well-conducted comparative clinical trials that favor the personalization of indications are lacking. Moreover, it is essential to review the previously described surgical techniques, seeing their historical and scientific value, when one proposes the standardization of a new surgical procedure.

Source: Miola AC, Alcantara GP, Miot LDB, et al. Considerations on the development of surgical techniques for the treatment of onychocryptosis. An Bras Dermatol. 2021;96(5):651-3.