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Hi,
Has anyone encountered patients whom hallux nails (The central nail portion not removed) has become fungal and detached from the nail bed after the phenolisation procedure?

This has occurred during post care at approx 3-4weeks for 2 of my patients.
Both of whom are healthy and young.

I am unsure if this can be from the procedure or from post op dressings. i.e Keeping dressed for too long.

Thanks in advance

 

Hi,

I've seen this plenty of times - from phenol destroying tissue around the eponychium and/or occlusive dressings. I doubt fungal presence if it wasn't there pre-op.
It's usually (the ones I've seen) down to bad technique. GP's used to do a lot of these procedures at one time.

Post-op just let the nail grow out - it should be quite normal once the new plate comes through.

 

Just to add to good the advice from Davidh, it's frequently the case that elevation of the nail margins tends to damage the 'adhesion' between the central portion of the nail and the nail bed. This allows the central portion to become detached and the situation is exacerbated by the salt water footbaths that the patient is advised to use post-operatively. I agree that if there is a true fungal infection it must have been there pre-op but would even if onychomycosis is confirmed, advise not treating this for at least 9 months when the 'new' nail will have grown and scrapings can be taken from that source.

All the best

Bill Liggins

 

I usually get any clients with sweaty hot feet to prepare pre-op by way of Lamisil cream treatment for 10 days. Sometimes fungal infection of the skin is not obvious, and this is a good way of combating post-op complications to an otherwise good op. Baring in mind that most infections are opportunistic, even very mild fungal infections of the skin are attracted to the traumatised nail (post-op area). Hope this helps.