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Saline is better than alcohol at getting rid of phenol

Discussion in 'Foot Surgery' started by NewsBot, Jun 12, 2012.

  1. NewsBot

    NewsBot The Admin that posts the news.


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    Enhanced Removal of Phenol with Saline Solution Over Alcohol: An In Vitro Study
    Damian Cordoba Diaz et al
    Dermatologic Surgery (online first)
    Full text
  2. Jonix

    Jonix Active Member

    Third option of not removing the phenol.. I have never tried to flush it out after nail surgery, ever since I trained !
  3. brekin

    brekin Active Member

    Since reading this thread in June I have been trialling flushing all my PNA's with Saline solution. So far, out of only a small sample of 4, it appears that the pain levels during the 1st review are reduced when using Saline flush. The worst of the 4 PNA's that I used saline on complained that it throbbed the first couple of nights and then had no pain but the rest stated that there was only minor discomfort or no pain whatsoever. I believe flushing with Saline solution will probably reduce post op pain of PNA's though I will continue to record client experiences for further validation.

  4. pg2608

    pg2608 Welcome New Poster

    Great sample size? I look forward to your published research
  5. Paul Bowles

    Paul Bowles Well-Known Member

    Havent we as a profession been doing this for over 10 years? With all respect to the article in the original post I believe its all been done before. The only concern flushing with alcohol is the lipophilic nature of phenol/alcohol and the fact it may spread and cause superficial tissue burns. Saline in copious amounts simply dilutes the phenol and moves it away from the site of application. I think in large enough quantities both would do exactly the same thing. The real question is why are we using phenol at all? Its carcinogenic when inhaled and I don't believe there are any studies in situ demonstrating that post nail/matrix resection that phenol application does what what the dogmatic textbook approach tells us it does. Happy for someone to post a peer reviewed research paper showing me though!
  6. brekin

    brekin Active Member

    Of course it is just anecdotal. I'm not saying that it definitely does reduce pain levels after operation. However when changing practice there's nothing wrong with keeping track of your patient experiences. The research already states, "When the wound was irrigated with ethyl alcohol, the total phenol recovered after two irrigation washes was 55.7% of the original amount initially used in treatment, compared with 80.4% when sterile saline solution was used for irrigation." It was an extrapolation that this may perhaps reduce post-op pain levels. Obviously extrapolations are not research but not all podiatrists have the time and numbers of PNAs to do a proper RCT. However, from an already disclosed very small sample size, I am so far happy with the results I've got. At the least it doesn't seem to increase post-op pain and there is a chance that it does reduce post-op pain levels.

    Now if you can point to any good research articles that say that post-op saline flushing does not help reduce post-op pain then I am more than willing to change my practice to what the evidence supports.
  7. Paul Bowles

    Paul Bowles Well-Known Member

    Saline irrigates the wound. Do it with saline, sterile IV solution, chlorhexidine, methylated spirits....I doubt the flushing agent has any effect on post operative wound pain. Logically how could it? The burn has already occured and as long as you are not liberally splashing phenol all over the tissue I fail to see how correct application could be assisted by variance in flush. It just makes no sense really.

    Phenol is reported in the literature to be a slight analgesic agent though - so there may in fact be some evidence to suggest flushing it at all would increase post op pain.

    At the end of the day, its a PNA - not life saving cardiac surgery. We are talking about regrowth options not mortality and morbidity options.

    Do what works for you.
  8. NewsBot

    NewsBot The Admin that posts the news.

    Alcohol Plus Chlorhexidine is More Efficient Than Alcohol Alone for Phenol-Based Chemical Matricectomy: An In Vitro Study
    Damian Cordoba Diaz , Ricardo Becerro de Bengoa Vallejo , Marta Elena Losa Iglesias , Manuel Cordoba Diaz
    Dermatologic Surgery; Early View

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