Onychocryptosis and Neutropaenia

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Are there any particular considerations to be made when treating a neutropaenic patient who has painful onychocryptosis?
I am aware that the major issue for neutropaenic patients is avoiding wounds, and the associated risk of infection. Neutropaenia may mask the normal signs of sepsis, and prophylactic broad spectrum antibiotics are commonly used.
It appears that neutropaenia alone should not affect the rate of healing, so long as infection is managed appropriately, and appropriate wound care is carried out.
In a neutropaenic patient I would be reluctant to carry out radical sharp debridement of a neuropathic wound, but would be interested in people's opinions around resecting onychocryptosis.
My experience and reasoning would lead me to remove the offending piece of nail if I was confident of doing so without causing further injury.
Any comments would be appreciated.
Damian Gough

 

Damian,
I would want to ensure any contributing factor to the neutropaenia was being managed, and that the neutrophil count is as high as possible before any procedure, so would closely with the patient's Physician.
Ultimately it is a risk benefit analysis. I have performed PNAs on oncology patients with low neutrophil counts, but only in close consultation with the oncologist, at the time the count is highest in the treatment cycle, and there have been others where we have even delayed the cutting of "difficult" nails till things improve.

 

I agree with Stephen here. However, I would always go for an incisional technique in such cases, simply because healing will be far more rapid than chemical cautery. A good opportunity for teamwork with the physician.

Bill Liggins

 

I agree with Stephen here. However, I would always choose an incisional technique, simply because the healing is more rapid and can therefore fall within the 'high' level of the treatment cycle. A good opportunity for teamwork with the physician.

All the best

Bill Liggins

 

Thanks Stephen and Bill.
I would not be considering cautery, or even an incisional procedure until neutropaenia has improved.
Stevens comments about the risk/benefit are key, along with close consultation with oncology team.
Understanding blood results and having accurate up to date neutrophil counts should be essential before considering any podiatry for cancer patients where skin integrity may be compromised.
Damian