Hi all,
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6/52 ago I performed a partial nail avulsion on a 15 yo male patient with a history of cryptosis with localised infection and associated hypergranulation tissue. The procedure went smoothly, I saw him later the same week for re-dress with Allevyn NA and Tubigauze which he was to replicate every 4-5/7 for three weeks and bathe the site in salt water for 4-5 mins between dresses. The site was healing well and after 3/52 we switched to a simple dry dressing (Cutiplast Sterile).
Since switching to the Cutiplast the site has continued to heal well with the exception of the area of what was hypergranulation tissue. It appears to have become quite fibrous and epithelial in nature, it also remains well vascularized. During the phenolisation at the time of the PNA I applied some to the hypergran and have been debriding the associated HK and applying silver nitrate since. The mass is smaller in size than at the initial PNA but improvement appears to have stalled in the last 2/52.
Does anyone have any suggestions as to how I may proceed? As I say it is still vascular and debridement with a blade is not really an option I wouldn't think. I also don't think that it would be a great outcome from the patient's point of view for an epithelial mass to remain in the sulcus.
Any imput or suggestions would be greatly appreciated.
Leigh
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