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Ingrown toenail surgery - phenol burn!

Discussion in 'Foot Health Forum' started by RSSFeedBot, Feb 10, 2009.

  1. RSSFeedBot

    RSSFeedBot I, Robot


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    I had the surgery 5+ weeks ago and have been in almost constant pain. It was lessening until today. After the second week, a red line has been...

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  2. MR NAKE

    MR NAKE Active Member

    ITS NOT EASY TO COMMENT ON A PROCEDURE THAT HAS BEEN DONE BY A DIFFERENT CLINICIAN, HOWEVER THIS SAID, TO A LESSER EXTENT, IF A PROCEDURE AS SIMPLE AS NAIL WEDGE RESECTION WITH PHENOLISATION MATRIXECTOMY IS DONE WITH ALL THE PROTOCOLS FOLLOWED, IE,

    SCRUBING WELL, NAIL BORDERS MARKED WELL, RELEASE FROM NAIL SULCUS WITH BLUNT DISECTOR, THWAITS USED CORRECTLY AND THE TIP JUST UNDER THE EPONYCHIUM WITH A STRAIGHT CUT THEN EITHER BLUNT DISECTOR/BEAVER TO COMPLETE THE REST WITHOUT ERROR (IT SHOULD GIVE WHEN PRESSED ACCORDINGLY, WITH A GENTLE AND FIRM PUSH)......THIS IS ONE OF THE IMPORTANT BIT AS ANY FAULT WILL RESULT IN A PIECE BEING LEFT IN THE MATRIX IT WILL GROW BACK NO QUESTION ABOUT THIS ONE.....ANATOMY DOES NOT PLAY DICE HERE.

    LETS CONTINUE, THEN AN ARTERY FORCEPS CAN BE USED TO CLIP THE CUT NAIL IN A SIMILAR FASHION AS THE LENGTH OF THE THWAITS AND MEDIALLY ROTATED UNTIL THE WHOLE MATRIX IS OUT (WITH THE MATRIX WHICH IS WHITE IN COLOUR AND COULD DIFFER IN LENGHTH THOUGH AT LEAST +/- 3mm, THEN AN ATTEMPT IS MADE TO SEARCH FOR EXTRA MATRIX BITS LEFT USING THE ARTERY FORCEPS....HALF THE TIME THE CLINICIAN IS EAGER OR KEEN TO GO ON.....ONE MAJOR PIT FALL...., THEN PHENOL APPLICATION, ANOTHER AREA OF GREAT DEBATE?????

    AND AND THE APPLICATION AND WORKING OF THE PHENOL..... ONLY I REPEAT ONLY ON THE MATRIX NOT THE NAIL BAD AS SOME CLINICIAN WHO PROBABLY DID NOT HAVE A SET GUIDELINES WHEN TRAINING ABOUT HOW MANY THEY AUGHT TO HAVE PERFOMED (UNDER STRICT SUPERVISION AS IN SOUTH AFRICAN PODIATRIC SCHOOL OF MEDICINE IS) BEFORE CERTIFIED COMPETENT CONFUSE WITH THE AREA OF PHENOL APPLICATION.......

    SECOND PITFALL AS SOME CLINICIANS DRAG THE BLACK'S FILE TO THE NAIL BED CAUSING MASSIVE CHEMICAL BURN THAT WILL CAUSE HEALING PROBLEMS HENCE I HAVE ARRIVED TO YOUR PROBLEM MY DEAR COLLEAGUE.

    ANOTHER ISSUE IS THE USE OF THE BLACK'S FILE MEDIALLY, THIS SHOULD BE AVOIDED AS IT RESULTS IN FURTHER TISSUE TRAUMA AND DEBRY (HOPEFULLY THIS WILL BE FLUSHED OUT WITH THE ALCOHOL).

    WITH PROPER 3X1 MINUTE AND DRAPING WITH STERILE DRY GAUZE INTERVALLY AND THE FINAL 1 FULL MINUTE IRRIGATION WITH ALCOHOL TO A GREATER EXTENT YOU SHOULD AT LEAST ACHEIVE SOME REPERFUSION ONCE THE TOUNIQUET IS OFF THEN YOU CAN USE BACTIGRASS (A GAUZE THAT IS IMPREGNANTED WITH A HEALING OINTMENT) TO PACK/ OR NOT PACK DEPENDING ON HOW ONE WAS TAUGHT/EXPERINCE AND (I NORMALLY USE TWO LAYERS...(A SMALL ONE FOR PACKING AND A TOP RETURNED TO COVER THE SURGICAL SITE), THEN AQUASORB AND KELTOSTAT TO HELP WITH THE CLEARING OF BOTH BLOOD AND EXUDATE WITH A FINAL RETURN STRIP GAUSE AND THREE DAYS LATER WITH POST EPERATIVE INSTRUCTIONS VOOOOOLA. NO COMPLICATIONS ( PHENOL BURNS, PROLONGED PAINS, POSSIBLE CELLULITIS, REVISIONS / NO REGROWTHS)

    FROM NOW ON DRY DRESSINGS AND SALT WATER BATHS.........HEALING WILL BE A VIRTUE UNEVENTIFULLY.


    AND I CAN ATTEST THAT ALL THESE REPORTS THAT I HAVE BEEN SEEING ON OUR WEBSITE HAVE BEEN TROUBLING ME FOR A WHILE AND THE FACT THAT NO ONE HAS EVEN ATTEMPTED TO DISCUSS THE ISSE IT MADE ME FEEL AS THOGH WE HAVE A COMMUNITY WHICH IS BUSY DOING WHATEVER SUITS THEM.......... OR MAYBE ITS A TRIVIAL SURGICAL PROCEEDURE NOT WORTH PONDERING ON......YOUR SUGGESTIONS ARE GREATLY WELCOME AS THIS IS FOR LEARNING PURPOSES........RIGHT.

    IF WE KEEP IT SIMPLE AND FOLLOW PROCEEDURES COMPLICATIONS WILL BE VERY MINIMAL......EASIER SAID THAN DONE FOR OTHERS BUT FOR ME A PIECE OF CAKE
     
  3. cornmerchant

    cornmerchant Well-Known Member

    Once again , testimony to the diverse protocols for nail surgery. The foot health forum is a complete joke- does the foot doctor seriously think that his reply was professional?
    As for Mr Nake , you may well think that your way is the best, and to be fair most of my protocol is the same as yours, but for goodness sake, phenol burn does not look a bit like infection which is obviously what this poster has!
     
  4. MR NAKE

    MR NAKE Active Member

    i am glad to find out that there is some similarity of practice across board, i am afraid i will not be able to comment on the foot doctor's reply (you could ask for his clinical reasoning though??), now then, i feel it will be good if you could describe for us how we can distinguish clinicaly the features of phenol burn and infection please??....there is a greater propensity for one/ both to occur after nail surgery because the bigest volume of bacteria is from the flora within the toe web spaces and sulcus of digits (see cambell 's operative orthopedic textbook (2008).vol 4, 11th ed p4461)(so effective scrubbing should be priority), and phenol burn from fluid driping from point of application which could masqurade as a form of tracking infection...(and if one hasn't examined that patient one would not be able to say with total conviction if its an infection only and not phenol burn)(culture will be rec), but we could give the initial threader's poster the justification for basing it on either phenol burn?, as he could have either queried phenol burn/infection together. your views are greatly appreciated of course.

    whose foot is it anyway?
     
    Last edited: May 4, 2009
  5. cornmerchant

    cornmerchant Well-Known Member

    Mr Nake

    I referred to the Footdoctor as unprofessional since he chose to tell a poster that his daughter was acting like a "subservient door mat".

    In 15 years I have had one patient that I had to refer for antibiotics, and one other patient who chose to seek antibiotics for herself against my advice. In my experience phenol burns do not track but stay very localised. Occasionally drainage is required if the scab closes over too quickly and exudate needs to disperse, this is remedied by debridement and clearance of the debris. I do not drip my phenol as it is applied carefully on cotton wool wrapped closely around a metal applicator.
    Out of interest, what is the year of publication of the text from which you quote? Its a pity that nail surgery is not left to the podiatrist, rather than being the remit of the orthopods.


    cornmerchant
     
  6. MR NAKE

    MR NAKE Active Member

    2008, and besides phenol drips are known to occur with certain clinicians. i am glad to hear that you are not one of them. as clinicians we have to have each other's back always :drinks

    whose foot is it anyway?
     
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