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Ingrown toenails can be caused by abnormal nail structure, irritation and pressure from poorly fitted shoes, and most commonly by improper nail trimming where the corners of the toenails are rounded off. Once the nail begins to grow into the skin, the body will begin to treat the nail as a foreign object, which results in pain and redness in the soft tissue on the side of the nail. If left untreated, the ingrown nail can begin to cut into the skin, which can lead to a skin tissue infection with oozing or a granuloma formation. (Granuloma is tissue around the ingrown toenail that is red, moist, and increases in size.)
Non-Surgical Treatment: If the ingrown nail is at the end of the toe, a simple procedure called a partial wedge resection (also called a slant back procedure) can be performed. This is performed by using a nail clipper in a slanted approach to clip off the offending portion of nail. Proper subsequent and routine nail trimming after a partial wedge resection can prevent the ingrown nail from recurring in most cases.
Surgical: In most cases, simply removing a wedge of nail at the tip does not completely resolve the problem, especially if the toenail is severely embedded within the skin.
Surgical procedures for treating ingrown nails are performed in the office. With the exception of the injection to deliver the local anesthetic, there should be no pain during the procedure. There are two major ways to remove the nail surgically. The first is a complete or partial nail removal. In this case the nail will grow back over the course of the next 9 to 12 months. In most cases as long as the causing factor (e.g. improper nail cutting or tight shoes) is avoided, the ingrown nail should not reoccur.
The second method is a partial or total chemical matrixectomy. With this method, a portion of the nail or the entire nail may be removed permanently. The nail matrix is a thin tissue layer under the nail fold that produces new nail; when this tissue is removed the nail no longer grows.
Nail Avulsion: In this procedure, the nail root, known as the matrix and found beneath the cuticles, is left alone. This will allow the nail to completely grow back. This procedure requires a local injection to numb the toe, a specially designed nail splitter to separate the nail from the nail bed, and a small clamp to remove the nail.
Local injection: Local anesthetic is injected into the toe to numb the area around the nail. The injection is not performed at the location of the ingrown nail but is injected at the base of the toe. Most patients describe the injection as a burning and stretching sensation.
Nail Removal: Once the toe is adequately numbed, the attachment of the nail to the soft tissue and cuticle is released. The portion of nail to be removed is then spilt from the nail plate using a blade and nail splitter. This is followed by removal of the nail with a thin clamp. Antibacterial cream is applied to the area, and the toe is dressed with bandages. It may take the toenail about 8 to 10 months to grow back to its original length.
Partial Chemical Matrixectomy/Total Chemical Matrixectomy: In this procedure, the nail root/matrix is removed chemically using either phenol or sodium hydroxide. This prevents the nail from growing back. The local anesthetic injection is performed using the same technique as in the above described nail avulsion procedure.
After the toe is adequately numbed, a tourniquet is applied around the toe to prevent blood flow into the area. Preventing blood flow prevents diluting the phenol or sodium hydroxide solution and keeps the chemicals strong enough to adequately destroy the nail root/matrix.
Nail Removal: When performing a "partial" chemical matrixectomy, a blade and nail splitter is used to cut out a portion of the nail. The blade and the nail splitter are applied to the end of the nail and gently pushed down through the nail plate to the cuticle. A fine-jawed clamp is used to remove the portion of the ingrown nail. Until this point in the procedure everything is the same as performed in the nail avulsion. Next a Q-tip with phenol or sodium hydroxide is inserted in the area deep and beneath the cuticle to kill the nail root. This procedure destroys the nail root on the side of the ingrown nail and allows the remaining nail to grow as usual.
If a "total" chemical matrixectomy is performed, the entire nail will be removed and the phenol or sodium hydroxide is applied to the entire area beneath the cuticle. In this case, the entire nail will not grow back.
Surgical Cautions and Complications: It is possible that all or part of the ingrown nail that was treated with the chemical may grow back. Since a chemical matrixectomy is a chemical burn, this procedure will cause mild draining during the healing process. This procedure creates a burn that is not suitable for patients who have poor healing or poor blood flow.
Post-Op Management: Between the time of the surgical procedure and the next appointment, Amerigel should be applied to the wound to aid in the healing process. While this wound is healing, it is expected to have mild drainage from the area with mild redness and swelling. Additionally, there may be some soreness, which can be alleviated with pain medication like Tylenol. Usually after the surgical removal of an ingrown nail, a follow-up appointment is scheduled in order to perform proper wound care to the surgical site and monitor the outcome of the ingrown nail removal.
Copyright (c) 2010 Bruce Lashley
Bruce Lashley, DPM
Dr. Lashley is a podiatrist practicing in midtown Manhattan for the past 27 years. He specializes in the conservative and surgical management of the foot. In October 2009, Dr Lashley moved his office to a new modern facility at 353 Lexington Avenue, in NYC. For more information on Dr. Lashley visit his web site.
http://www.footdoctornyc.com/
Xbox 360 Red Ring - a Great Guide Written by Experts
Early editions Microsoft's Xbox 360 gaming console occasionally encountered a problem that commonly came to be known as the Red Ring of Death. Caused by a number of defective components, Microsoft pinpointed the hardware malfunctions and promptly made changes on their assembly line. If you aren't familiar with the xbox 360 red ring, here are a few causes and possible fixes for the error.
First of all, the overall unit would overheat. Of course, this was not a basic problem as it was always the result of several different smaller components causing overheating or doing so themselves. For instance, the normal amount of heat that the processors emitted would weaken the integrity of a few screws and solder joints. This would cause those places to weaken, which in turn would affect other components to malfunction. The easiest way to fix this, then, was to replace the weak screws, namely the ones holding the X-clamps in place.
However, if you are going to remove the X-clamps, you may also want to look at the heat sink and the CPU and GPU which are under the clamps. Remove the heat sink and clean it, as debris has been known to interfere with its operation, as is with the processors. Apply a new thermal compound to the heat sink and put it back on the motherboard. When you replace the X-clamps use new, stronger screws to fasten them in place tightly. This should solve the problem.
The graphics card itself may also be the culprit so if increasing structural integrity does not remove the xbox 360 red ring you will probably need to replace it. Microsoft designed the first graphic chips in house to save money, but unfortunately wasn't able to match the quality of the outsourced chips they use today. Without a warranty you will have to purchase and replace the chip yourself.
Is Your XBox360 In Need Of Repair, But You Don't Know Where To Turn? This Tried And Trusted Review Site Will Provide You With The Best XBox Repair Guides on How to repair a Xbox Online Today So That You Can Make An Informed Choice
About the Author
What is wrong with my xbox 360?
ok, please you must be really advance to know what this is.
basicly, its a xbox 360 arcade system mfed 2007 (falcon NOT jasper) and it E74 lately and turned in to RRoDE74 (both) and since i thought i could repair it, i took it out its case etc.. and took out the mother board drive, plastic vacume etc... and unscrewed 1 clamp beneth the heatsink and screwed the motherboard back on because im missing screws for the clamp, and without the plastic case , it shows E74 on my TV when i put the case together, it turns on Shows me 3 red lights then the fans increase speed (u can hear it changing speed levels) until it reaches max speed Really damn loud and it switches to 2 lights aka overheating, what do i need to do to fix it?? thanks and nos tupid coment sayin get a life and a ps3 or some other shit like that.
u should have just sent it to microsoft and got it repaired but u voided the warrenty so u just going to hav to get another one
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