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Rheumatoid arthritis and nail surgery?

Discussion in 'General Issues and Discussion Forum' started by mburton, Aug 11, 2011.

  1. mburton

    mburton Active Member


    Members do not see these Ads. Sign Up.
    I have a patient with established RA struggling between meds for this (at present Hydroxychloroquine suphate) that make her nauseous, and those for her hiatus hernia.

    She has a lot of joint pain, but the reason she comes to me is to tidy up the mess from 2 failed GP hallux total nail avulsions. She was told that the LA was a faulty batch on the first op and therefore the procedure had to be abandoned. Unfortunately the second op (by same GP) has also left significant and troublesome regrowth.

    I would prefer to avulse and phenolise again, hopefully for a more satisfactory definitive treatment, but the original referral came via her GP from one of our consultant surgeons who stated that 'I would have significant concerns doing redo surgery or phenol ablation on a lady with established RA'.

    She is a middle-aged lady with no other obvious health problems, pedal pulses are palpable, B/halluxes are hyperextended with small spicules of regrowth, particularly in the sulci. I don't foresee the actual area(s) requiring phenolisation to be very big, but of course am aware of the potential problems with healing and RA.

    I would value any opinions/insights/advice , and especially from those who may have more experience of treating RA patients.

    best wishes
     
  2. Jose Antonio Teatino

    Jose Antonio Teatino Well-Known Member

    Scottish Dear Colleague:
    There is no problem to use Phenolization your patient.
    I have over six thousand procedures in my experience.
    Sincerely:

    Jose A. Teatino
    Professor of surgery
    The Academy Ambulatory Foot & Ankle Surgery
     
  3. toughspiders

    toughspiders Active Member

    Hiya

    This situation is a sticky one really.

    You say she has come for a "tidy up" im guessing from this that the lady wants this for aesthetic reasons.

    I presume the previous healing was without complication

    I presume she doesnt have significant microvascular issues? Raynauds?

    Her meds, her illness and her consultants opinion are against her.

    Personally, if its was my decision.. it would be a NO but this is broadly based on the fact that im assuming its for cosmetic reasons only. If not then thats another issue.

    Hope this helps, just my two pence worth :bash:
     
  4. W J Liggins

    W J Liggins Well-Known Member

    It would be a good idea to obtain a copy of the notes which might explain precisely why this surgeon felt it inappropriate to carry out nail surgery. It will also indicate whether this was an orthopod, a general, a vascular or other surgeon. You could also have a word with him/her.

    Hope this helps

    Bill Liggins
     
  5. mburton

    mburton Active Member

    Thanks to you all for your suggestions.

    Toughspiders - not just cosmetic, there are regrowth spicules right in the sulci and painful, but the whole nailbed is flaky and dystrophic.

    Bill, it's a vascular consultant and I have much respect for him. That's why I posted really - thought I must be missing something and wanted to be prepared. Guess next step is to have a word with him!
    Thanks again
    Mo
     
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