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nail surgery in the presence of onychomycosis

Discussion in 'Foot Surgery' started by ELM, Oct 22, 2010.

  1. ELM

    ELM Member


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    Have been faced with the need to perform a partial nail avulsion (with matrix phenolisation) on a patient who also has onychomycosis of both 1st nails (the nails in question). The infection is currently being treated with Daktarin tincture with good effect, and we are managing the discomfort of involuted 1st with packing in the medial and lateral sulci.

    The nails are partially o'lytic, but intact. Would the presence of o'mycosis stop anyone performing the procedure?

    Looking forward to your views,
    Erin
     
  2. Footsie 100

    Footsie 100 Member

    Hi there,

    After an appropriate pre-operative assessment to ensure there are no contraindications to performing the surgery, you have 2 main choices for surgery. (1) You could ablate the entire nail, treat with topical anti-mycotic agents and then watchful waiting for nail regrowth. The nail may well grow back in a dystrophic state +/- mycosis. (2) You could ablate the entire nail and phenolise the matrix & nail bed and be done with the problem.

    In both cases, you might find that the nail fragments somewhat during the ablation and so you should ensure that all nail fragments are removed.

    In my opinion, the presence of mycotic infection should not ordinarily present a contraindication to nail surgery.

    Regards

    Footsie 100
     
  3. drsarbes

    drsarbes Well-Known Member

    No, go ahead.
     
  4. Ian Drakard

    Ian Drakard Active Member

    Just bear in mind with post-op dressings covering the area there is a good chance of TP flare up over the toe- just actively treat as needed
     
  5. As Steve says, pile in. Done plenty of TNAs on fungal nails and never had any problems beyond the very occasional TP flare which Ian described, which is easy licked with some topical antifungals.

    I'd only do a PNA if I were able to Avulse all the fungal nail OR if I did a PNA, phenolised, then avulsed the central part of the nail WITHOUT phenol (so it grows back).

    But that seems to be making it needlessly complex to me.
     
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