Hypergranulation after Nail Surgery

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Hi there,

7 weeks ago, I performed a PNA with phenolisation on a male patient, 20 years old. The same proecedure had been performed on the patient last year but unfortunately not enough of the nail was removed and I had to redo it. Anyway, there were no complications.
For 1-2 weeks now, there has been hypergranulation from the wound, and it also appeared infected. I advised the patient to get antibiotics from his GP, which he did. The hypergranulation tissue did not disappear. I have now applied silver nitrate, but thought I would ask whether anyone's got any thoughts on this... Like, how often do you usually apply the silver nitrate?
Understandably, after several months with this, the patient is finding te experience increasingly distressing...

 

At 7 weeks post-op it is probable that the condition is arising from a 'crease' in the nail caused by temporary damage in the process of the procedure. As this crease grows with the nail, it can penetrate the ungulabia resulting in a granuloma. It will grow out in due course.

Hope that this helps

Bill Liggins

 

I agree with Liggins.
I call it "scale" to this effect, the growth yield, but may speed healing from a gouge or knife cutting espiculotomía practicing.
This procedure is usually not necessary to apply a local anesthetic.
greetings:
Jose Antonio Teatino.
Full Professor of Surgery
The Academy of Ambulatory Foot & Ankle Surgery

 

A picture is worth a thousand words.
Sorry my bad English

 

Gracias.

Mejor que mi Espanol!

Bill

 

many thanks for all the useful replies! I have the patient come in on Wednesday, so will be able to have a close look. and yes, i agree with bill, i wish everyone's spanish was as good as your english! mine isn't either unfortunately!

 

Google's automatic translator works miracles ...

 

Since both you have been very helpful in this, I thought I'd just post a quick update in case you are interested. The silver nitrate has reduced the hypergran, and the area looks all clear. I am confident it will still heal normally. Infection has been resolved as well, and redness has effectively disappeared.

Thanks again!