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Nail surgery problem

Discussion in 'Introductions' started by toeguy, Aug 2, 2010.

  1. toeguy

    toeguy Welcome New Poster


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    Hi, can anyone help?

    I have carried out numerous PNAs with phenolisation of the nail matrix and I have never come across something like this. Recently I had a patient who developed what I believed to be a reaction to the phenol and this had the effect of rotting the nail. There was hypergranulation present and the reaction spread from the corner of the PNA site and gradually worked its way across the nail bed. See attached photograph. The only way I could resolve the problem was to remove the entire nail and allow it to grow back, which it did quite normally. Has anyone else encountered this problem?
     

    Attached Files:

  2. Footsie 100

    Footsie 100 Member

    Toeguy,

    Regarding the nail plate destruction, it may be that more nail plate was elevated during the first part of the procedure than was actually removed. Phenol would then track under this additional elevated section and cause the damage noted by the proximal nail fold and along the entire side of the nail plate. This can happen when the nail plates are thin, more nail elevates than might be expected.

    Regarding the hypergranulation tissue formation at the proximal nail fold this could be the result of the rough nail margin irritating then lateral nail fold and / or incomplete removal of the nail section leaving a slightly wider section proximally (eponychial level) that would cause this tissue reaction.

    Anyway, those are my thoughts.

    Regards.

    Footsie 100
     
  3. Heather J Bassett

    Heather J Bassett Well-Known Member

    Welcome Toe Guy and Footsie.
    Nice photo and great reply. I have seen this a number of times.
    When bathing, cleaning and dressing the nail the moisture can seep under the edge and the area becomes a macerated mess.
    Just the affected area can be redefined with great results and less trauma but will depend on the situation.
    Look forward to further input from you both.
    Cheers
     
  4. JMD

    JMD Member

    This has also happened to me on a few occassions. Initially I thought that I had left a spicule of nail in place which may have been the causitive factor but further investigation under LA showed this not to be the case. I also considered that tracking of phenol under the elevated nail may have been a factor but although this is possibile I am always very careful when applying the phenol to apply slight pressure to the nail plate to prevent this. Thin nails seem to be most affected. Heather's suggestion may be correct.
     
  5. Footsie 100

    Footsie 100 Member

    I wonder what the original poster thought of the replies? It’s a shame they haven’t acknowledged the responses.
     
  6. toeguy

    toeguy Welcome New Poster

    Sorry Footsie I have been away for a few days.
    Thanks for the response. My initial thought when this occured was that there was an incomplete removal of nail and like JMD I investagated under LA but the area was completely clear. The pt also assured me that post op instructions were followed to the letter so it was unlikely that this was the cause of the infection. I still feel that it was a reaction to the phenol and it is interesting to note that other practitioners have experienced similar problems.
     
  7. Heather J Bassett

    Heather J Bassett Well-Known Member

    Hi footsie, some of us get on here every day of the year and then some of us get on once a week or month etc.

    It is great when members acknowledge the input from the peers, the time lines will always vary.

    Nice of you to brring this to the discussion, thanks :)

    Cheers
     
  8. Footsie 100

    Footsie 100 Member

    Hi Heather,

    Good point made and noted.

    Regards.

    Footsie 100
     
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