phenol resistance?

Members do not see these Ads. Sign Up.

Has anyone ever heard of a patient who was resistant to phonolization? I have two collegues who have patients who have had PNA's with phenolization done 3 or 4 times with different practitioners and different phenol, only to have regrowth each time.

 

Yes, I've seen it myself, for those patients that I am currently dealing with I plan to do use NaOH instead of phenol to see if this does the trick...if all else fails will need to go to a winograd.

 

Yes, I have a few patients now that I am dealing with.... I plan to switch to NaOH instead of Phenol...and if that fails will need to resort to a winograd.

 

My thoughts are that this probably has little to do with the phenol itself, but simply either faulty technique (failure to remove all of the nail plate or debris, as when it splits or crumbles with mycosis, and that will obstruct phenol), the nail matrix is very thick, or a even a combination thereof. After 2 recurrences, it is sharp excision time no matter what the cause.

 

Rick is correct, its the clinicians issue NOT the patients. Make sure the phenol is not out of date, has no crystals forming in solution, etc, etc... Make sure your application is in a bloodless field, check your application technique and time.

If the tissue blanches due to the phenol, then it cannot be the phenol causing the issue. If you have no blanching of tissue - its your phenol or technique.

Although patients may be more or less sensitive to timed applications (i.e. some people may require 30 secs, some 4 mins) I would anticipate no-one is "resistant to phenol". This is why applications time should be based on tissue change not the clock.

I also agree, after 2 shots a sharps technique is indicated.

On a side note, I unsure that phenol in a "PNA" or "P & A" procedure does anything at all. All of the research is not done in situ, hence there is no clear data on exactly what phenol does to matrix cells in a wound. I would argue nothing replaces gentle and accurate resection of nail segment with matrix intact.

Based on a pilot study we completed a few years back on 14 patients where no phenol was applied during a partial nail avulsion (PNA) we had follow up at 2 years where we had 13/14 with no nail regrowth and successful outcomes. This is in line with literature which suggests a failure rate using phenol of about 8% +

Now I am not saying the pilot was perfect but it does raise questions about dogmatic approach to phenol use.

So my question to the broader Podiatry community is that besides chemical cautery, what exactly does phenol do?

 

Phenol resistance is a new one to me - never heard of it before and never come across it. I think it goes back to the points already covered - surgical technique, phenol no longer effective, blood in the operative field, insufficient phenolisation time. Has any but anecdotal evidence shown resistance to phenol in properly executed nail avulsion with local anaesthesia?