Dr Jenaleen Law1, Dr Aruna Wijewardena1, Dr Shane O’Neill1
1Royal North Shore Hospital, St Leonards, Australia
Introduction: Ingrown nails (onychocryptosis) occurs when the nail plate pierces the lateral nail fold and penetrates into the skin as a result of trauma, mechanical, or anatomical factors. It can cause inflammation or infection in the surrounding skin and interfere with the performance of daily activities. Ingrown nails typically affect the toes but can also affect the fingers. This case series describes two patients who developed ingrown fingernails following severe hand burns.
Cases: A 42-year-old gentleman suffered 43% TBSA deep dermal flame burns to his face, neck, and bilateral upper and lower limbs in a factory explosion. A 33-year-old gentleman suffered 33% TBSA deep dermal burns to his face and all four limbs in the same incident. Both patients required escharotomies for circumferential upper limb burns which were later debrided and covered with skin grafts. They underwent reconstruction to correct contractures of the palms, webspaces, and fingers. They also developed contractures causing the glabrous skin of the finger pulps to retract onto the dorsal surface of the fingers, towards the proximal nail folds. The resultant nail bed distortion lead to ingrown fingernails, which caused severe pain and required surgical treatment.
Conclusion: To the best of our knowledge, this is the first case series of ingrown fingernails following hand burns. It is postulated that the burns contractures distorted the nail bed and lead to the development of problematic ingrown fingernails. We hope this presentation will increase awareness and prompt further reporting of the functional long-term sequelae and management of hand burns.
Unaccredited Burns and Plastics Registrar at Royal North Shore Hospital, Sydney.