Nail Surgery Repeated Regrowth

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Hi everyone,

I am hopeing that someone will have some advice formy treatment of a patient. The latter has now had PNA with phenolisation performed 4 times (inlcuding twice by myself, and I have been extra thorough given the previous events), and each time regrowth has occurred. I am just wodnering whether anyone else has had such cases, and whether you would recommend that I continue trying this procedure until it works...

Regards,

Mike Zini

 

Hi

I would tend to carry out an incisional procedure at this stage. There will be a great deal of fibrosis around the matrical area which may well prevent penetration of phenol (or other chemical).

All the best

Bill Liggins

 

Many thanks for your reply, Bill. so basically if it hasn't worked the previous few times it will never?

The sharp excision is precisely what the patient does not want to undergo...
in the uk that would be done by a podiatric surgeon via gp referral, right?

there is a laser alternative to the chemical as well, as far as i know... to your knowledge, might that be sth worth trying out?

Thanks again for your help!

Best,

Mike Zini

 

Hi Mike

If the patient is really averse to incisional treatment then you could try actual cautery using a hyfrecator. I have no personal experience but some practitioners find it a useful technique. I suppose that you could try sodium hydroxide in place of phenol but you may end up with the same problem.

Hope this helps

All the best

Bill

 

Test increasing exposure times of phenol.
Can use a matrix infiltration with Dermojet bleomicinaen alternatively, in addition to the previous proposals.

 

Hi Mike,

When this occurs, I just use an additional application. If that fails, I will add an additional application. If that fails, I will add a seperate application of monochloracetic acid. About every 10 years or so, I have to do this.

Regards,

Stanley

 

Hi Mike

You don't say in which part of the world you practice, but if you're in the UK then I counsel you to avoid using monochloracetic acid for this purpose. There are guidelines for various procedures that are different in the USA and monochlor for this purpose is not a recognised procedure here.

All the best

Bill

 

Hi Bill,

I practice in the USA. I have not heard of Monochloracetic acid being used prior to my usage, and I haven't reported it. I just use it in the really rare cases (once every 10 years or so) that do not respond to an additional 50% of phenol application.
I was just wondering what you do in the UK if the guidelines are not enough to help a patient?

Regards,
Stanley

 

Hi Stanley

Per my previous, I would go for an incisional technique, for example a Winograd or Frost type of procedure. Failing that, there is sufficient published evidence to suggest that actual cautery could be used. It's really a case of insurance and most of the carriers here would not support the use of unproven or unreported techniques, unless it was part of an approved trial supported by the professional body and put through the local hospital or university ethical committee.

I'm interested in your experience and not suggesting that your procedure is any way wrong, but simply that Mike (if he is in the UK) could run into trouble if he used it, and heaven forbid there was a problem.

All the best

Bill

 

hi guys,

many thanks for your helpful comments thus far! And yes, I do pratcise in the UK, Bill.

All best,

Mike

 

Take a sample of DNA [Blood] and send it to Oxford for analysis and held aid tissue regeneration around the world - perhaps there is a unique gene that could be isolated ^_^ (Although said off the cuff - in all serious it might be worth considering referral to medical science tissue that just keeps re-growing is kinda handy)