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Nail Surgery Issue

Discussion in 'General Issues and Discussion Forum' started by TerrySheehan, Jan 12, 2012.

  1. TerrySheehan

    TerrySheehan Member

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    Can anyone help me. One of my colleagues recently did nail sugery on an older gentleman. When he was assessed by both my colleague and I we agreed there wasn't any medical reasons to not do the nail surgery. He had the surgery on a tuesday and on friday wasn't any different to what you would expect from a total nail avulsion with phenolisation. Over the weekend however his toes became very inflammed and swollen and his foot has now swollen up to the ankle. He is on antibiotics since his foot swelled and the nai bed is relatively dry but has only just started with the macerated edges you would expect with phenol. Has anyone else seen a reaction like this as its not one we have seen before. I personally haven't seen the patient since the surgery but my colleague is concerned and hopefully things will improve soon. Any advice?
  2. Disgruntled pod

    Disgruntled pod Active Member

    I was talking to a colleague who had done a course taught by pod surgeon Stuart Metcalffe.

    To cut a long story short, a bunion surgery in north London. Ankle block used. Next day ankle swells up badly and pt admitted to casualty. Even though there is no evidence that pre-opping works, the pt won the litigation as no pre-opping had been documented.

    Me: With nail surgery, Hydrex sprayed onto injection site, documented in notes. Iodine onto nail area. BN and exp dates documeted. Instruments fresh out of steriliser with cycle no. documented in notes.

    Wrt adverse outcomes, you are only required to state in consent form, the most frequently occurring risks. You are not required to state every single risk that is possible.

    Did your patient have a change in medicines, not tell you about a drug that they are on?

    Hope this helps!
  3. TerrySheehan

    TerrySheehan Member

    all notes thoroughly documented and knowing my colleague fully up to date, contempraneously. Both of us saw the patient, me first initially and referred to colleague for nail surgery which I would have happily done myself. Medication checked and full assessment completed and documented with nail surgery templates on the system. Doplar even done due to patients age. capillary refill 4secs. No reason not to do surgery that we are aware of
  4. Jose Antonio Teatino

    Jose Antonio Teatino Well-Known Member

    It has curettage in the procedure?
  5. W J Liggins

    W J Liggins Well-Known Member

    The most common adverse reaction is, as you say, infection and it would therefore be worth doing a C & S since staph.aureus isn't the only potentially infecting organism. Pseudomonas is not that uncommon, and occasionally a streptococcus.

    If negative for infection, I have seen premature closure of the wound result in localised inflammation (but never to the ankle). Should this be the case, it is simple to establish and maintain drainage.

    Hope this helps

    Bill Liggins
  6. Gibby

    Gibby Active Member

    I have had patients show edema and localized erythema after nail avulsion/matrixectomy procedures... it is usually due to premature wound healing. The few days of serous drainage usually seen after phenol use does not happen due to premature wound healing. I will usually debride locally, do a C&S, and instruct the patient to bathe/shower the foot as they did before the procedure---
  7. drsarbes

    drsarbes Well-Known Member

    Given the information that ALL HIS TOES ARE INFLAMED AND SWOLLEN and has swelling UP TO THE ANKLE:
    Here is my DD:

    1. Acute bacterial infection (culture, blood work, start on broad spectrum antibiotics, soaks, dressing.)
    2. Acute Phenol Reaction (if all tests in #1 are negative, start on oral cortisone and topical cortisone)
    3. Acute phlebitis/embolism (check calf. Order venogram. Start on blood thinners, warm compresses)
    4. Acute arthritic Flareup
    5. Acute Vasculitis
    6. Acute Regional Pain Syndrome


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