Консультация
2 марта (2 недели назад) в поликлинике удалили вросший ноготь хирургическим путем с наложением 2 швов. Удалили не весь ноготь, а краешек и разрезали рядом палец. Хирург ничего толком не объяснял. Разрезал, обработали, забинтовали и отправили домой. Сказали обрабатывать самой фурациллином и спиртом. На ночь накладывать левомеколь.
9 марта сняли швы. Сказали дальше обрабатывать. И закрыли больничный с 10 марта.
Палец, конечно, спустя, неделю выглядит получше. Швы заживают понемногу. Отек пальца практически спал. Но по утрам, когда иду на работу (в сапогах), из нижнего уголка ногтя выделается розовато- желтая жидкость. Немного, но каждый день. И место это побаливает. Хотя остальные швы не болят.
Когда прихожу на работу, сапоги снимаю. Но в любом случае вечером палец покрасневший в этом месте особенно.
Муж меня успокаивает, говорит, что швы так быстро не заживают. Но я очень переживаю. Ведь прошло уже 2 недели с момента операции. Вечером прикладываю левомеколь минут на 30-40. Сплю без повязки. Утром палец выглядит сносно. Но как только схожу на работу — опять эта беда.
Что мне делать? Стоит ли идти срочно на прием к врачу? Или все- таки подождать еще? И как можно ускорить заживление ранки.
Вросший ноготь на ноге или руке – довольно неприятный и болезненный недуг. Такому заболеванию подвержены люди любых возрастов. Причин может быть много. Самыми распространенными из них являются: неаккуратное подстригание ногтей и ношение неудобной обуви.
Виды операций
На сегодняшний день любая медицинская клиника предлагает следующие методы устранения патологии:
- оперативное лечение с помощью скальпеля (удаление вросшего ногтя полностью или частично);
- лазерная коррекция;
- пластика околоногтевого валика;
- операция при помощи радиоволн.
Хирургический метод
Врастающий ноготь можно корректировать хирургическим путем с помощью скальпеля. Операция проводится только после подтверждения действия анестезии и длится не более 30 минут.
Если ноготь начал врастать, образовывая при этом участки с гноем, врач может поставить тампонаду. Иными словами, под ногтевую пластину помещают специальный мягкий материал, который пропитан антисептическим средством. Как только гной устранили, проводят операцию по удалению вросшего ногтя:
- Проведение краевой резекции – удаление части ногтя под углом 45 градусов. Не самый надежный способ устранения патологии, так как зачастую она возвращается вновь.
- Проведение селективной резекции с удалением части матрикса. По статистике рецидив заболевания случается только в 2% случаев.
- Проведение полного удаления ногтя — быстрый и простой метод избавления от вросшего ногтя, но повторное врастание может все равно случиться.
- Проведение фенолизации ногтевой пластины, то есть полное удаление ногтя. Вырасти заново он уже не сможет. Такая операция назначается редко.
Лазерное лечение
Воздействие на ноготь лазером – прекрасный метод удаления вросшего ногтя навсегда. Преимуществами такого лечения являются:
- пожизненное избавление от проблемы. По статистике всего лишь 1% случаев такого лечения сопровождается рецидивом;
- соседние участки повреждаются крайне редко. При лазерной операции происходит удаление только пораженной ткани. Ростковые области ногтя остаются неизменными;
- короткий восстановительный период. В этом случае можно говорить о том, что заживление проходит недолго, при этом боль и дискомфорт почти не наблюдаются;
- осложнения возникают крайне редко. Следует отметить отсутствие возможного кровотечения и занесения инфекции;
- лазерное лечение безопасно и для детей.
Пластика околоногтевого валика
Иными словами, операция Шмидена. Данное лечение довольно болезненное, поэтому его проводят с применением анестезии, которую вводят по обе стороны от поврежденного ногтя. Перед проведением операции на основание пальца накладывают жгут, который поможет предотвратить кровотечение при вмешательстве.
Следующий этап – проведение рассечения ногтя маленькими ножницами. С помощью ножниц надрезают мягкие ткани, а после иссекают гипергрануляцию. Далее иссекают фрагмент матрицы ногтя.
Завершающий этап – это швы, которые накладывают на рану. Также можно просто закрыть рану повязкой. Полностью она заживает через неделю. Во избежание возникновения негативных последствий рекомендовано менять повязку каждый день.
Радиоволновое лечение
Такой вид лечения характеризуется удалением только врастающих боковых краев. При этом травмирование рядом расположенных мягких тканей не происходит. После осуществления такой операции повторное врастание ногтя не происходит.
Преимущества лечения радиоволнами в том, что на операцию понадобится не более 15 минут, возможность лечения на любой стадии болезни, безболезненность лечения определяется местной анестезией. Также стоит учесть, что накладывать швы не нужно. После операции достаточно наложить повязку, менять которую можно и в домашних условиях.
Правила соблюдения в послеоперационный период
Как вести себя после операции и каков должен быть уход за пальцем? После проведения операции и окончания действия анестезии прооперированное место может болеть. В период заживления необходимо следить за чистотой прооперированного участка, чтобы не занести в него инфекцию. Каждый день следует проводить обработку ложа ногтя с помощью антисептиков. Это может Хлоргексидин или Перекись водорода. Также рекомендовано применять антибактериальную мазь.
Перевязывать палец нужно только стерильным материалом. На протяжении первых нескольких суток необходимо обеспечить конечность полным покоем. Если того требует ситуация, можно принять обезболивающее средство. После операции на пальце ноги следует носить широкую обувь, которая обеспечивает минимальный контакт с прооперированным пальцем.
Если уход проводился правильно, вернуться к привычному образу жизни можно уже ко второй неделе. Боль может пройти даже на следующий день после операции.
Осложнения
Ни одна клиника не даст гарантии того, что не возникнут осложнения после проведения операции. Так, могут быть следующие осложнения, такие как развитие лимфаденита и лимфангиита. Этому способствует развитие инфекции в лимфатических сосудах, что вызывает воспалительный процесс. В некоторых случаях может возникнуть абсцесс пальца. Иными словами, это воспалительный процесс в мягких тканях, который сопровождается выделением гноя. Также возникает отечность и покраснение всего пальца.
Остеомиелит ногтя также может быть, как осложнение после операции удаления. В этом случае гнойная инфекция переходит на кость, что почти не поддается излечению. В трудных случаях врач назначает операцию по ампутации всего пальца.
В особо запущенных случаях может наблюдаться гангрена пальца. Первый симптом – почернение всего пальца. Единственным выходом выступает ампутация всего пальца.
В любом случае, если имеются все признаки такого патологического состояния и боль долго не проходит, необходимо обратиться к специалисту для решения проблемы. В этом поможет любая клиника, специализирующаяся на данных проблемах.
Вросший ноготь или онихокриптоз – это врастание в боковой край ткани ногтевого валика части ногтевой пластины. Наиболее часто страдает внешний край большого пальца ноги. При врастании ногтя ногтевой валик краснеет, отекает, возникает воспалительный процесс, который сопровождается сильной болью.
Не все замечают, что ноготь врос в кожу, и обращаются к врачу уже на стадии нагноения и нестерпимой боли. Вросший ноготь в половине случаев становится хроническим явлением.
Почему врастает ноготь?
Ноготь врастает в палец вследствие ряда внешних причин:
- неправильно проведенный педикюр (в 95 % случаев) — срезание уголка ногтя, оставление острого края, заусениц, очищение свободной части ногтя кончиками ножниц. После обрезания ногтя не должно оставаться закругленного края, нельзя слишком коротко состригать ноготь.
- узкая, несоразмерная обувь, с узкими носами (см. туфли балетки -причина вросшего ногтя), при постоянном давлении на ноготь он изменяет направление своего роста.
- повышенная нагрузка на ноги
и некоторых заболеваний:
- грибок ногтевой пластины — грибок ногтей приводит к его деформации и утолщению, врастанию в околоногтевой валик
- плоскостопие, вальгусные стопы — происходит и деформация стопы, и искривление большого пальца, поскольку на него давит второй палец стопы
- врожденное избыточное количество мягкой ткани в подногтевой подушке
- беременность — часто возникает вросший ноготь у женщин вскоре после родов (через 1,5-2 месяца) в период грудного вскармливания или на поздних сроках беременности
- травма пальца или отморожение
- заболевания, нарушающие питание ногтя — эндокринные патологии, сахарный диабет, ожирение, сердечно-сосудистые заболевания
- кожные заболевания — псориаз, бородавки, лишай и пр, которые способствуют деформации ногтей
- лечение онкозаболеваний — химиотерапия, лучевая терапия отрицательно влияют на постоянно активно растущие клетки
Симптомы и признаки вросшего ногтя
Признаки вросшего ногтя большого пальца ноги:
- Боль в области ногтевого валика со стороны врастания ногтя, постоянная, усиливающаяся при ходьбе и ношении обуви.
- Язвочка в месте врастания ногтя
появляются в результате травмирования.
- Валик опухает, краснеет, появляется пульсирующая боль — это присоединение инфекции, при этом появляются гнойные выделения.
- Чрезмерное разрастание тканей (грануляции) цвета сырого мяса на пальце ноги.
- При длительном течение – необратимые изменения ногтя, деформация, утолщение и укорочение пластины. Огрубение мягких тканей. Нагноение.
Обследование
Чтобы исключить развитие осложнений и быстро вылечить вросший ноготь обращаться следует к хирургу или подологу (заболевания стоп). Он направит на:
- общий анализ крови — чтобы оценить выраженность воспаления
- анализ крови на глюкозу — для исключения сахарного диабета
При подозрение на грибок ногтей на ногах — следует обратиться к дерматологу для комплексного лечения, поскольку в этом случае вросший ноготь является лишь следствием грибкового поражения, а лечить последствия, а не само заболевание — бесперспективно.
При наличии осложнений хирург направит на рентгенографию стопы, чтобы определить наличие или отсутствие гнойного процесса на кости, а также исключить такую патологию как остеофит (костный вырост на пальце), симптомы которого схожи с онихокриптозом.
Консервативное лечение
Оно эффективно в начальной стадии заболевания, поэтому не затягивайте с посещением врача, проводится в домашних условиях:
Ванночки и компрессы
- Дезинфицирующие ванночки с растворами марганцовки, пищевой соды, морской соли (каждый день, поочередно) по 2-4 раза в сутки. Размягчение тканей приводит к естественному освобождению вросшей части ногтя. После таких процедур попробуйте аккуратно удалить ноготь и обработайте место йодом. Ванночки делайте до исчезновения признаков онихокриптоза.
- Прикладывание кусочка стерильно бинта, смоченного в растворе Хлоргексидина, между ногтем и кожным валиком. По мере высыхания бинт смачивают в антисептике. Каждый день бинт немного продвигают вперед, освобождая еще большую часть ногтя. При усердном выполнении такое домашнее лечение весьма эффективно.
- Компресс: его делают на ночь в течение 3-4 дней, если воспаление не снимается, то следует обращаться к хирургу. Состав: 10 мл димексида развести с 20 мл воды, 1 амп. анальгина, 1 мл. дексаметазона. Смачивается таким раствором тампон из марли, прикладывается к пальцу, сверху целлофан, забинтовать, одеть носок на ночь.
- Можно использовать такой способ: пилкой для ногтей пропиливают на вросшем ногте вертикальную бороздку (только на роговом слое). Эта бороздка будет затягиваться, поднимая таким образом край вросшего ногтя.
- При начавшемся воспалении (пульсирующая боль, покраснение, отек), такой способ подходит только в самом начале воспалительного процесса для его купирования, если начался абсцесс пальца этого делать нельзя и следует обратиться к врачу. Опускать воспаленный палец в емкость с очень горячей водой (кипятком) на 1-2 секунды (настолько — насколько можно терпеть) и так несколько раз (20-30 раз за 10-20 минут), затем повторять процедуру до исчезновения боли и воспаления.
- При сильной боли, возможно, прием внутрь НПВС (порацетамол, нимесулид, ибупрофен и пр.)
Во время лечения соблюдайте следующие правила:
- Ношение свободной обуви
- Безукоризненная гигиена стоп
- Смена носков 2 раза в день
- Правильное подстригание ногтей (приведено ниже).
Мази и растворы при вросшем ногте
Ноктинорм 
Это бальзам, который размягчает ногтевую пластинку, облегчает обрезание, снимет боль и воспаление.
Состав: экстракты солодки, маклеи, горофит зверобоя, пальмовое масло и вазелин.
Применение: 1-2 р/день, перед использованием следует распарить ноги, чтобы из-под ногтевых валиков вышли уголки ногтя, затем нанести бальзам на валик и всю ногтевую пластинку.
Уродерм 
Состав: Основное действующее вещество мази мочевина (карбамид), которая смягчает ткани и ноготь, облегчая срезание вросшего ногтя.
Применение: До стрижки ногтя следует наносить мазь в течение 3-4 дней. Наносится на сухой палец, специальной лопаточкой следует заправить крем между околоногтевым валиком и краем ногтя, одеть носки и оставить на некоторое время. Через 3 дня можно подстричь ноготь.
Левомеколь 
Применяется только после хирургического вмешательства.
Состав: антибиотик левомицетин и метилурацил, улучшающий регенерацию тканей.
Применение: После операции накладывается повязка с левомеколем до полного очищения раны.
Мазь Вишневского 
Применяется при присоединении инфекции.
Состав: касторовое масло, березовый деготь, порошок ксероформа.
Применение: Наносится мазь на ночь под повязку, утром снять, если ноготь вышел из-под валика — можно его срезать.
Ихтиоловая мазь 
Состав: вазелин, ихтаммол.
Снижает боль, воспаление, раздражение, уничтожает бактерии, размягчает ногтевую пластинку.
Применение: На ночь делается повязка с ихтиоловой мазью, утром снимается и можно остричь ноготь.
Скобы и пластины
Они приподнимают край ногтя, при этом не приносят дискомфорта, можно носить обувь. Скобы внешне чем-то напоминают брекеты для зубов. Устанавливаются на ноготь только врачом.
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Хирургическое лечение включает ряд методов
Резекция края врастающего ногтя или всей ногтевой пластины
Удаление вросшего ногтя — это операция, которую проводят под местной анестезией. Если ноготь гноится, чаще всего снимают всю ногтевую пластину. Новый ноготь вырастает в течение 3 месяцев. К сожалению, после операции с большой частотой через 3-4 месяца возникают рецидивы заболевания. Поэтому проводится профилактика рецидива, которая заключается в пластике ногтевого валика: удалении грануляций и части кожи по боковой поверхности пальца. Ногтевой валик перестает контактировать с ногтевой пластиной.
Лазерное прижигание
Лазер вросшего ногтя и ростковых клеток ногтевой пластины после удаления вросшего ногтя. Показано при врастании ногтя на уровне кутикулы. Высокотехнологичный метод, приводящий к стойкой ремиссии. Пучком лазера выжигают ростковые клетки и часть вросшего ногтя, одновременно удаляют воспаленную ткань и грануляции. Лазерная коррекция является наилучшим методом лечения вросшего ногтя.
Радиоволновое удаление вросшего ногтя
Щадящая методика, после операции не остается шва, а вероятность осложнений и рецидива является минимальной. Во время операции ликвидируется вросшая часть ногтя, а также обрабатывается матричная и ростковая зона.
Что делать после операции по удалению вросшего ногтя?
- После резекции ногтевое ложе оголено и некоторое время вызывает боль. Заживление происходит длительно в течение месяца, и в этот период важно защитить ткани от присоединения инфекции.
- Ежедневно в течение 3-5 дней проводится обработка ногтевого ложа антисептиками (Хлоргексидином, перекисью водорода) и антибактериальной мазью (Левомеколь, Гентаксан, Офлокаин), перевязка пальца стерильными материалами. В последующем перевязку делают через день.
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Что делать, если ноготь врос у ребенка?
В этом случае следует немедленно оправляться к врачу – болевой порог у детей очень высокий, поэтому самостоятельные действия могут только усугубить ситуацию. Как лечить вросший ноготь на ноге у ребенка, врач решит после осмотра.
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