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phenol burn/reaction question

Discussion in 'General Issues and Discussion Forum' started by Berms, Apr 22, 2009.

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  1. Berms

    Berms Active Member


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    Hi Folks,
    Apologies if this has been covered before, but I was wondering why different people react so differently to the phenol used in the common Phenol and Alcohol procedure.

    I have done hundreds using the same same 2 X 45secs application times and the same volume of phenol (small curette head filled with phenol) but 1 or 2 out of ten procedures will result in a phenol reaction/burn at the site.... causing some minor tissue damage and hypergranulation tissue locally (but usually not involving surrounding tissue due to careful application of the phenol and no contact with this skin). The result is painful and delayed healing, despite all receiving the same post-op dressing and management - bacti-gras and 2 layers of hypoallergenic elastoplast.

    Naturally this is something neither the patient or I want. Can anyone shed any light or pick up something I am doing wrong?
     
  2. MR NAKE

    MR NAKE Active Member

    dear colleague

    i do share your sentiments there will be 1 or 2 odd ones who will be allergic to phenol, but not severe enough to cause an anaphylactic shock. the most interesting thing is in South africa we were taught the 3x1 minute phenol application witha syringe (small one +/-0.5ml) with interval gauze dapping and then redoing it and working with a black's file,.......a bit different to your approach, but it will be common to have these incidents however, the amounts of phenol burns were so little then and now and allergic reactions are few, untill a clinician becomes a bit over the top.........i suggest you dap the phenol with a dry gauze or apply vaseline on the sorrounding ares as others do......a bit daunting aint it?.

    the most intresting part is some clinicians in the UK trusts i work in have argued that we dont need bactigrass and neither keltostat( coz it deries up a lot) only dry dressing will suffice.....
     
  3. delpod

    delpod Active Member

    in my time as a student and then practicioner observing other podiatrists i have witnessed a number of different phenol application methods as well as dressing regimes.

    As a student i was taught the 3 x 30 seconds (90 sec total) phenol application using thinned down cotton probes dipped in the phenol. This method seems to work quite well given the fact that the thinned down probes make minimal contact with the nail sulcus upon application of the phenol to the matrix (so to avoid something along the lines of "sqeezing the water out of a mop" as can happen with a thicker probe end which makes more contact with the nail sulcus - thus more unwanted phenol contact in areas besides the nail matrix).

    I have observed other podiatrists who simply dry dab the area with gauze instead of rinsing with alcohol with the idea/belief/research that alcohol doesnt really "deactivate" phenol action and all the flushing does is spread the phenol elsewhere...i personally dont agree with this notion at all.

    Dressing wise, bactigras or jelonet with some sort of foam and tube gauze or combine to cover everything up nicely is what I was shown as a student however I have seen other podiatirsts simply soak a foam dressing in betadine rather than use a bactigras.

    I would be interested in hearing about the preferred dressing regimes of others, both initially after the surgery and in follow up (of course only if it is deemed relevant to the original poster's thread)
     
  4. MicW

    MicW Active Member

    Delpod, I've always used the same cotton bud technique you outlined but 10 X 15 second applications i.e. 2.5 minutes followed by alcohol flush. Results have been great with minimal Px discomfort.

    Dressing has been bactigras, cutiplast, handigrip. Redress in 3 days followed by 2 more days bactigras, cutiplast. Thence daily application of betadine sparingly and simple cover.

    Works for us
     
  5. delpod

    delpod Active Member

    MicW, thats quite a lot of phenol application, almost double what I was taught. How does the tissue hold up for this? Also i'd assume that with more phenol application, you'd see even less nail regrowth than the "usual" 3%?

    Do you advise NaCl toe soaks?
     
  6. MicW

    MicW Active Member

    Delpod, agree this is greater than the amount of phenol you employ. Our method is in line with my teachings (Sydney mid 90's). Of course the application of this amount is flexible - for instance a Px with sensitive skin or a child would receive reduced quantity. At time of redress there will often be evidence of tissue damage along the sulcus in question, but as reported last night Px discomfort is minimal. I have done well in excess of 1000 of these procedures and my colleagues more on top. Regrowth incidence would be 1%.

    Saline bathe we recommend after redress - 1 teaspoon to 1 litre for one or two minutes.

    Regards MicW
     
  7. Berms

    Berms Active Member

    Aside from differing techniques and phenol application times, are others experiencing this rate of phenol "reaction / burn" of 1 or 2 out of ten? I still can't understand why some heal beautifully and have absolutely no reaction and others look horrible at the 1 - 2 week mark, are much more painful and take much longer to heal? - especially since they all receive exactly the same procedure?
     
  8. LeonW

    LeonW Active Member

    I have heard that blood deactivates the phenol and Alcohol as well. I suppose it bleeds a bit when u take off the tourniquet that should fix the phenol. Anybody can confirm this?
     
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