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Background: Acute traumatic wounds are a common and distressing event for patients presenting to plastic surgery clinics. There are no definitive conclusions regarding the benefits of collagen-based wound care products toward the application on full-thickness wounds compared to traditional ointment or gauze care. In this clinical trial, we aimed to define the potential benefits of collagen-based dressings on healing through the comparison of collagen-based composite dressings with antibiotic ointment dressings. Methods: This was a randomized two-tailed controlled clinical trial. The acute full-thickness wounds underwent wound cleansing, debridement, and were secured with different dressings in both experimental and control groups. The wounds were subsequently photographed weekly, and the wound areas were calculated using ImageJ software to evaluate wound healing rate. Results: The results demonstrate that the collagen-based triple layer composite dressings which consisted of silver sheet, collagen sponge, and foam films promoted better epithelialization and healing than antibiotic ointment treatment. Collagen supplementation improved wound healing and epithelialization by providing a dry environment during the late stage of wound healing. Conclusion: We demonstrated that the collagen-based triple layer wound dressing could potentially increase the healing rate when used for traumatic full-thickness wound care compared to the conventional antibiotic ointment dressing, providing a new prospective in the future applications of wound care.

Acanthamoeba spp. boleh menyebabkan keratitis kepada manusia, khasnya kepada pemakai kanta sentuh yang tidak menitikberatkan aspek higen kanta sentuh. Kajian ini bertujuan untuk mengkaji keberkesanan antibiotik titisan mata Gentamicin terhadap sista Acanthamoeba isolat klinikal iaitu HKL 5, HKL 11, HKL 32, dan HKL 51. Kajian dimulakan dengan melakukan suspensi sista terhadap keempat-empat isolat klinikal tersebut. Mikropencairan terhadap antimikrob dilakukan dan kemudiannya suspensi sista ditambah, seterusnya dieramkan selama 24 jam pada 30oC sebelum dipindahkan ke atas plat agar bukan nutrien (NNA) yang dilapisi E. coli matian haba. Plat agar diperhatikan setiap hari sehingga hari yang ke-14 untuk mengesan sebarang kehadiran trofozoit di bawah mikroskop inverted. Kehadiran trofozoit Acanthamoeba menunjukkan bahawa antibiotik ujian tidak berkesan terhadap sista Acanthamoeba. Gentamicin berkesan terhadap sista Acanthamoeba, dengan nilai purata sistisidal minimum (MCC) 1453.1 μg/ml. Gentamicin merupakan antibiotik yang boleh digunakan dalam rawatan keratitis Acanthamoeba memandangkan kepada keberkesanannya terhadap sista Acanthamoeba isolat klinikal dalam kajian ini. __________________________________________________________________________ Acanthamoeba spp. may cause keratitis in humans especially amongst the contact lens wearers who do not practice good hygienic care of contact lenses. This study aims to evaluate the effectiveness of Gentamicin on four clinical isolates of Acanthamoeba cysts from Kuala Lumpur Hospital consisting HKL 5, HKL 11, HKL 32, and HKL 51. Cysts suspensions of all 4 clinical isolates of Acanthamoeba were prepared. Microdilution of antimicrobial was prepared and cyst suspension was added and later incubated at 30oC for 24 hours before being transferred onto non-nutrient agar (NNA) plates seeded with heat-killed E.coli. The plates were observed daily until day 14 to detect the presence of trophozoites under inverted microscope. The presence of trophozoite stage indicates ineffectiveness of the tested antibiotic towards Acanthamoeba cysts. Gentamicin was found to be effective against Acanthamoeba cysts with MCC mean value of 1453.1 μg/ml. Gentamicin could be used for the treatment of Acanthamoeba keratitis as it exhibited cysticidal effect on all isolates of Acanthamoeba cysts in this study. Keywords: Topical antibiotic eyedrop, Gentamicin, Acanthamoeba, Malaysia

The problem of effective treatment of the local surgical soft tissue infection has not yet been completely solved. The use of topical antibiotics, in particular neomycin, is one of the possible ways to solve this problem. The use of topical drugs that contain neomycin or combinations of neomycin and other antibiotics showed high efficacy of these drugs in the comprehensive treatment of wounds in various pathologies in combination with a low incidence of undesirable reactions.

We report two cases of corneal coinfection with Acanthamoeba and Fusarium sp. along with the review of published literature. A 35-year-old woman and 65-year-old man presented to the institute with corneal ulcer refractory for treatment with topical antibiotics. Microbiological examination revealed the presence of Acanthamoeba cysts along with septate, hyaline fungal filaments. After emergency therapeutic penetrating keratoplasty (TPK) in both, the corneal tissue was sent for histopathologic examination, which confirmed the presence of Acanthamoeba and fungal coinfection. One patient had a recurrence of fungal infection after TPK. In subjects with a rapid progression of mycotic ulcer, coinfection with other microorganisms including Acanthamoeba should be suspected. The two cases presented here emphasize the importance of microbiology in making prompt diagnosis and appropriate management of these cases at an early stage.

Clinical trials have demonstrated that sheep with footrot treated with parenteral and topical antibiotics without foot trimming (treatment A), cure faster than sheep treated with foot trimming and topical antibiotics (treatment B). We investigated how key players in the UK sheep industry recommended treating footrot, and tested whether reviewing the evidence surrounding treatment of footrot changed their beliefs. Eight key players attended a workshop to investigate their current practices, and their perceived efficacy of treatments, using probabilistic elicitation. At the start of the study, all participants recommended use of antibiotic injection but only four recommended not foot trimming feet with footrot. Initial beliefs in the difference in cure rate within five days of treatment ranged from 30 to 97% in favour of treatment A (true difference 60%); this heterogeneity reduced after reviewing the evidence. Participants who believed the cure rate differed by60% over-estimated the cure rate of treatment A whilst participants who believed the difference was60% over-estimated the efficacy of treatment B. During discussions, participants stated that parenteral antibiotics had always been recommended as a treatment for footrot but that the new research clarified when to use them. In contrast, it was highly novel to hear that foot trimming was detrimental to recovery, and key players and farmers are taking longer to accept this evidence. Three months after the workshop, two participants stated that they now placed greater emphasis on rapid individual antibiotic treatment of lame sheep and one was no longer recommending trimming feet.

Introduction Platelet rich plasma (PRP) is rich in growth factors and has been shown to improve healing in a variety of wounds. We determined the effects of PRP on healing and scarring in full thickness porcine burns with and without tangential excision and grafting (TEG). Methods Standardized full thickness 5 cm by 5 cm burns were created on each of the backs and flanks of 10 anesthetized female pigs (25 kg) using a validated model. The burns were created with a heating device that emits heat at a temperature of 400 °C for a period of 30 s. The burns were randomized to one of six treatments: no TEG or PRP, no TEG + PRP, early (day 2) TEG and no PRP, early TEG + PRP, late (day 14) TEG and no PRP, and late TEG + PRP. Tangential excision was performed down to viable tissue and autografts were 0.2 mm thick. When used, a thin layer of autologous PRP was applied below the graft. All wounds were then treated with a topical antibiotic ointment 3 times weekly for 42 days. Digital images and full thickness biopsies were taken at 9, 11, 14, 18, 21, 28, 35 and 42 days after injury to determine percentage reepithelialization, scar depth, and scar contraction. Tissue sections were stained with H&E and viewed by a dermatopathologist masked to treatment assignment. Results There was no reduction in platelet and white blood cell concentrations in PRP and blood samples for the first 14 days after-full thickness burns. A total of 120 burns were created on 10 animals evenly distributed between the six treatment groups. Burns undergoing early TEG reepithelialized fastest and with the thinnest scars followed by late TEG. Burns that did not undergo TEG had the slowest reepithelialization and greatest amount of scarring. Application of PRP had no additional effects on reepithelialization, scar depth, or scar contraction in any of the treatment groups. Conclusions Addition of PRP had similar effects on reepithelialization and scarring of full thickness porcine burns as standard topical antibiotic ointment regardless of whether the burns underwent excision or grafting or the timing of excision and grafting.

JS Pelletier,1–3 SB Barone,1 JA Capriotii1,2 1Department of Ophthalmology, Veloce BioPharma LLC, Fort Lauderdale, FL, USA; 2Department of Ophthalmology, Plessen Ophthalmology Consultants, Christiansted, VI, USA; 3Department of Ophthalmology, Ocean Ophthalmology Group, Miami, FL, USA Abstract: The Boston Type I Keratoprosthesis has been improving in both design and safety since its inception. Due to particular features inherent in the Boston Type I Keratoprosthesis eye and certain aspects of the ocular surface, special attention is required to maintain these implanted devices. There is currently a prominent role for keratoprosthesis prophylaxis; it is designed to prevent infectious complications like keratitis and endophthalmitis. This standard-of-care therapy has anecdotally been shown to improve outcomes; however, it has not been examined in the setting of controlled clinical trials. Moreover, concerns remain with the chronic utilization of topical antibiotics in that they may engender antibiotic resistance and select for opportunistic populations to establish a foothold on the ocular surface. We believe and introduce the idea that there is merit in exploring other compounds besides antibiotics for prophylaxis such as antiseptics like povidone-iodine. Specifically developed formulations of povidone-iodine may prove useful in both improving keratoprosthesis safety and simultaneously mitigating concerns regarding antibiotic resistance. Keywords: keratoprosthesis, ocular surface, povidone-iodine, antimicrobial resistance

Background Ocular superglue injury is uncommon all over the world. Aim To report a case of self-inflicted accidental ocular superglue injury. Methods A case of ocular injury is described in a 29-year-old adult, following inadvertent instillation of superglue instead of a prescribed steroid ointment into the right eye, in the dark. Results There was matting of the upper and lower lid margin and eyelashes precluding view of the ocular structures. The eyelids were separated by gently peeling off the superglue from the lids and lid margins. The glue-matted eye lashes were trimmed and the glue on the cornea and conjunctival surface was gently removed. Subsequently, a corneal ulcer was seen which was managed with topical antibiotics, systemic analgesics, and vitamins. Conclusion Similarity between the tubes of eye ointments and household superglue accounts for the accidental eye injury.

Background and Objectives Laser generated shockwave (LGS) is a novel modality for minimally invasive disruption of bacterial biofilms. The objectives of this study are to determine the mechanisms behind LGS treatment and non-biofilm effects on bacterial disruption, including (1) comparing bacterial load with and without LGS in its planktonic form and (2) estimating bacterial cell permeability following LGS. Study Design/Materials and Methods For the first study, planktonic S. epidermidis were treated with gentamicin (0, 8, 16, 32, 64 μg/ml) with and without LGS (1064 nm Nd:YAG laser, 110.14 mJ/mm2 , pulse duration 9 ns, spot size 3 mm, n = 8/group), and absorbances at 600 nm compared. For the second study, four samples of planktonic S. epidermidis were treated with LGS (same settings). Propidium iodide (PI) uptake via flow cytometry as a measure of cell permeability was measured at 0, 10, and 20 minutes following LGS. RESULTS: In comparing corresponding gentamicin concentrations within both LGS-treated samples and controls at 0 hours, there were no differences in absorbance (P = 0.923 and P = 0.814, respectively). Flow cytometry found modest PI uptake (10.4 ± 2.5%) immediately following LGS treatment, with time-dependent increase and persistence of the signal at 20 minutes (R2 = 0.449, P = 0.048). CONCLUSION: Taken together, LGS does not appear to have direct bacteriocidal properties, but rather by allowing for biofilm disruption and bacterial cell membrane permeabilization, both of which likely increase topical antibiotic delivery to pathogenic organisms. Insight into the mechanisms of LGS will allow for improved clinical applications and facilitate safe and effective translation of this technology. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.

espanolMujer de 46 anos, sin antecedentes de interes, natural de Honduras y residente en Espana desde hace un mes y medio. Acude a urgencias por inflamacion del parpado superior del ojo derecho, con zona que simula absceso. Se procede a drenado del mismo (sin obtener apenas contenido purulento), se prescribe tratamiento con antibioticos y antiinflamatorios topicos y orales. A la semana siguiente acude con mejoria del cuadro inflamatorio, pero con molestias y erosiones corneales. Tras eversion del parpado superior se observa parasito tipo «gusano» emergiendo del tarso. Se completa extraccion del mismo con pinza, identificandose como Dermatobia hominis (Dh) mediante examen en fresco. La evolucion posterior de la paciente resulto favorable. Discusion La celulitis preseptal en pacientes procedentes de zonas tropicales y subtropicales puede ser causada por Dh. EnglishA 46-year-old woman with no relevant medical history, native of Honduras and resident in Spain for one and a half months. The patient went to the Emergency Department due to inflammation of the upper eyelid of the right eye, with an area that simulated an abscess. This was drained (obtaining hardly any purulent content). Treatment was prescribed with oral and topical antibiotics, as well as an anti-inflammatory drug. One week later the patient returned, with improvement of the inflammatory signs, but with discomfort and corneal erosions. After eversion of the upper eyelid, a «worm» type parasite emerged from the tarsus. The extraction was completed with a clamp, and was later identified as Dermatobia hominis (Dh) by examination of a fresh specimen. The subsequent outcome of the patient was favourable. Discussion Preseptal cellulitis in patients from tropical and sub-tropical areas can be caused by Dh.

Purpose: To report the first successfully treated case of recurrent tube exposure in a patient with the Boston Keratoprosthesis type 1 with a collagen matrix patch graft (Ologen). Observations: A 50 year-old female with a Boston Keratoprosthesis type 1 and a history of Axenfeld-Reiger syndrome presents to our department with recurrent glaucoma drainage device exposure in her left eye. After failed spontaneous closure with topical antibiotics and lubricants, she undergoes tube exposure repair using an Ologen patch graft. Surgery was successful and the patient did not have any recurrence up to last follow-up two years post-operatively. Conclusion: Collagen matrix patch graft seems to be advantageous in treating glaucoma tube exposure in the Boston KPro eye, which is often a more challenging entity to treat. Importance: Collagen matrix patch graft could be considered as a primary patch graft in treating tube exposure in eyes with the Boston KPro. Keywords: Boston Kpro, Glaucoma drainage device, Tube exposure, Ologen

Background:Chronic osteomyelitis is a catastrophic sequel of delayed diagnosis of acute osteomyelitis.Objectives:The objectives of the study were to determine bacterial flora and antibiotic sensitivity, and to evaluate the outcome of an aggressive surgical approach to chronic osteomyelitis.Methods:This is a single surgeon, prospective cohort study on 30 consecutive patients with clinically and radiologically diagnosed chronic osteomyelitis presented to a hospital. We prospectively recorded demographic, clinical, radiological features, treatment protocol, microbiologic results of culture and sensitivity. The main treatment outcome measures were clinical signs of eradication of infection.Results:Microbiologic results showed that Gram-negative and mixed flora accounts for more than half of chronic osteomyelitis cases whileStaphylococcus aureuswas a dominating single pathogen (39%). We detected a high resistance rate to common antibiotics,e.g.83% ofS. aureusisolates were resistant to oxacillin (MRSA). The mean duration of bone infection was 4.2 years (3 months to 30 years) and the mean number of operations was 1.5 (1-5) . The mean follow-up was 15 months (12-18 months). Infection was eradicated in 95% (21 out of 22) treated by a single procedure and in all patients (n=8) by double procedure.Conclusion:Presented the high rate of MRSA strains is alarming and calls for updating of the antibiotic therapy guidelines in the country. Good results in treatment of chronic osteomyelitis can be achieved by a single-stage protocol including radical debridement combined with systemic and topical antibiotic.

Background The prescription of topical antibiotics for the prevention of infections in uncomplicated wounds is common. However, the efficacy is not well reported. Therefore, the objective of the study was to conduct a systematic review and meta-analysis of the available evidence on prevention of uncomplicated wound infections by prophylactic topical antibiotics. Materials and methods The search included Pubmed, Google Scholar, SCOPUS, Embase, Cochrane, ClinicalTrials.gov, International Clinical Trials Registry Platform, National Technical Information Service, and the National Guidelines Clearinghouse. Results We identified eight randomized controlled trials and four quasi-randomized trials that met the criteria for the systematic review. Of these trials, 11 studies were pooled for meta-analysis to compare the effects of topical antibiotics versus placebo and 4 studies were pooled for comparison of effects of topical antibiotics versus topical antiseptics on uncomplicated wounds. Fewer wound infections occurred in the topical antibiotic arms compared to placebo (pooled risk ratio: 0.57 [95% CI: 0.37 to 0.86]; p=0.01 and pooled risk difference: −3.1% [95% CI: −5.8% to −0.34%]; p=0.03). Compared to antiseptics, topical antibiotics demonstrated statistically significant relative risk reduction (pooled risk ratio: 0.56 [95% CI: 0.23 to 0.91]; p=0.02), while there was no significant absolute risk reduction (pooled risk difference: −3.7% [95% CI: −7.9% to +0.6%]; p=0.09). Conclusion Topical antibiotics are effective in reducing wound infections after surgical procedures, but the absolute benefit is small. Given the global emergence of antimicrobial resistance, judicious use of antibiotics is encouraged and use of antiseptics should be considered as a reasonable alternative to topical antibiotics., Video abstract

Purpose: To report the case of Phthirus pubis infestation of the eyelashes presenting as chronic blepharoconjunctivitis. Case Report: A 6-year-old girl presented with a 2-month history of blepharoconjunctivitis unresponsive to topical antibiotics in the left eye. Slit-lamp examination revealed the presence of nits and adult parasites on the eyelashes. Parasitological examination confirmed adult forms and nits of Phthirus pubis. There was no evidence of infestation elsewhere. Outcome was favourable with mechanical removal and application of petroleum jelly. Conclusion: Careful slit-lamp examination of the eyelashes should be done in all patients presenting with ocular irritation symptoms.

Endogenous endophthalmitis complicated by necrotising scleritis has rarely been reported in the literature. We, hereby, report a case of bilateral scleral perforation with endogenous endophthalmitis in an 87-year-old female patient with diabetes who presented as bilateral orbital cellulitis. Systemic workup ruled out autoimmune aetiology. The culture and sensitivity of exudates exuding from the scleral perforation showed Escherichia coli. The Patient was managed conservatively with parenteral and topical antibiotics along with steroid, but the vision could not be salvaged. The report emphasizes on atypical presentation of endogenous endophthalmitis. In old and immunosuppressed individuals presenting with a clinical picture of bilateral orbital cellulitis with profound vision loss, endogenous endophthalmitis should be ruled out.

The global push to combat the problem of antimicrobial resistance has led to the development of antimicrobial stewardship programs (ASPs), which were recently mandated by The Joint Commission and the Centers for Medicare and Medicaid Services. However, the use of topical antibiotics in the open surgical wound is often not monitored by these programs nor is it subject to any evidence-based standardization of care. Survey results indicate that the practice of using topical antibiotics intraoperatively, in both irrigation fluids and powders, is widespread. Given the risks inherent in their use and the lack of evidence supporting it, the practice should be monitored as a core part of ASPs, and alternative agents, such as antiseptics, should be considered.

Purpose. The aim of this study was to evaluate the method of intavitreal injections and its technique used for intravitreal injection procedure as well as possible intra- and post-injection complications and approaches used for their prevention. Material and methods. The article reports own clinical practice experience and comprehensive review of Russian and foreign trials assessing intravitreal injection technique and possible intra- and postinjection complications. Results. The intravitreal injection technique is simple to perform in clinical practice. Rate of injection associated complications is low and generally is related to accidental violations of the injection procedure technique. Complications are mostly associated with the use of drugs not licensed for intravitreal injection and/or aseptic condition violation. Rational antibiotic use during intravitreal injection procedure implies adequate evaluation of topical antibiotic requirement. Conclusions. An extensive literature search supposes that local asepsis, but not use of topical antibiotics is essential for prophylaxis of injection-associated complication.

Background: Surgical site infection (SSI) after minor surgery in primary care can compromise cosmetic outcomes, delay wound healing and increase costs. In addition to efficacy, adverse effects must be considered when considering antibiotic prophylaxis. There is no prior published literature regarding the proportion of general practitioners (GPs) who use topical antibiotics as SSI prophylaxis following minor surgery. Objectives: To identify the proportion of GPs in a regional center in Queensland, Australia who apply topical antibiotics to wounds prevent SSIs after minor surgery. Method: A database of 90 GPs was established, and they were invited to complete a questionnaire. Results: The response rate was 62% (56/90). Topical antibiotics prophylaxis was reported as being used always or sometimes in routine practice by 18% (10/56) of participants after both skin lesion excision and repair of lacerations. In the context of high-risk situations, on the other hand, use was higher. They were more likely to be used in high-risk situations, most frequently in diabetic patients(41.0% [23/56]) and immunocompromised patients (46.5% [26/56]). Conclusions: Evidence-based prescribing of antibiotics is vital. Topical antibiotic prophylaxis is often prescribed excessively after clean dermatological surgery, however, in our sample of GPs, only 18%used topical antibiotics always or sometimes in their practice.

Evidence from recent research suggests that prompt treatment of footrot with injectable and topical antibiotic is key to reducing the prevalence of lameness. In addition, routine foot trimming should be avoided. Trimming increases the prevalence of lameness because of damage to sensitive tissue and careful trimming that avoids damage to sensitive tissue, almost impossible under normal farm conditions, is not of benefit; it does not reduce the prevalence of lameness. On farms where these measures are put into practice, the prevalence of lameness falls to and remains below 2%. More farmers are adopting these recommendations, and there has been a reduction in the flock prevalence of lameness from 10% to 5% between 2004 and 2013.

Wound healing and wound infection is not enough standardized in practice of surgeon. Existing recommendations on local antimicrobial agents do not contain references to specific products and do not explain their key features. The role of antiseptics and local forms of antibiotics in the treatment of wounds not completely defined, that gives the impression of an identical indications for their use. In reality topical formulations differ significantly in their chemical structure and mechanism of action. Recommendations for treatment of fresh and infected chronic wounds need to be adjusted, as many antiseptics and antibiotics have both positive and negative impact on the course of wound healing when applied topically

There is increasing evidence that topical antibiotics, given before and/or after intravitreal injections, are ineffective in preventing endophthalmitis and are possibly harmful. In addition to the lack of efficacy and increased development of resistant organisms, the use of topical antibiotics adds significantly to the cost of delivering intravitreal therapy. Despite this, in many countries, it is still common practice to use pre- and/or postinjection topical antibiotics. This review outlines the general principles of effective antibiotic prophylaxis, and the evidence regarding topical antibiotic use as a prophylactic measure for endophthalmitis following intravitreal injections. A key distinguishing feature of intravitreal injections from most other invasive procedures is the fact that they are often repeated on multiple occasions to the same eye. Given the lack of evidence to support topical antibiotics as an effective method of prophylaxis for postinjection endophthalmitis, it appears that more widespread education of ophthalmologists is required to avoid continued inappropriate use. Revision of drug labels in some jurisdictions, and amendment of local/professional society guidelines, may be required to assist in achieving this goal. Emphasis should be placed on antisepsis and aseptic technique, which are the major proven methods of endophthalmitis prevention, rather than antibiotics.

Highlights • Haloduracin and chloramphenicol exhibited synergistic effect against pathogens. • The synergy indicates possibility of reducing the effective dose of chloramphenicol. • Reduction of chloramphenicol dose minimizes its negative side effects. • This shows a new window of using antibiotics and bacteriocins in combination therapy., The emergence of drug-resistant pathogens has triggered the search for more efficient antimicrobial agents and formulations for treatment of infections. In recent years, combination therapy has become one of the effective clinical practices in treating infections. The present study deals with the effect of haloduracin, a lantibiotic bateriocin and chloramphenicol against clinically important bacteria. The combined use of haloduracin and chloramphenicol resulted in remarkable synergy against a spectrum of microorganisms including strains of Staphylococcus aureus, Enterococcus faecium, Enterococcus faecalis and different groups of Streptococcus. The synergy allowed using these antimicrobial agents at substantially reduced concentrations without compromising their efficiency. Use of lower doses of chloramphenicol can avoid the severity of its side effects. In addition to minimizing undesirable side effects of some drugs, this approach brings the possibility of using antibiotics that are no longer effective due to drug resistance. Furthermore, the observed synergy between haloduracin and chloramphenicol opens a new window of using bacteriocins and antibiotics in combination therapy of infections.

INTRODUCTION: Ingrowing toenail (IGTN) or onychocryptosis is not uncommon in children and adolescents. However, there is a dearth of evidence in the literature on the management of IGTN in this age group. This study aimed to compare the results of nonoperative treatment for IGTN with that of operative treatment among children and adolescents. METHODS: All children and adolescents who were treated for IGTN at our institution between 2010 and 2014 were included for this retrospective study. Demographic data, treatment prescribed and outcome at six months after presentation were analysed. RESULTS: Overall, 199 patients were recruited. There were 123 (61.8%) boys and 76 (38.2%) girls. Median age was 14 years. Among 199 toes, 162 (81.4%) were treated nonoperatively, with nail care advice, topical antibiotics and daily cleansing. Only 37 (18.6%) toes were treated operatively. In the operative group, 23 (62.2%) patients underwent wedge resections, while the remaining 14 (37.8%) had total nail avulsions; for all patients, germinal matrices were preserved. At the six-month follow-up, there were 5 (3.1%) cases of recurrence in the nonoperative group when compared to 3 (8.1%) recurrences in the operative group. CONCLUSION: We recommend that IGTN in children and adolescents be treated in the first instance by nonoperative methods. Operative options can be considered for resistant cases or in case of recurrence of IGTN.