Members do not see these Ads. Sign Up.

Hi all :), I am having a discussion with colleagues regarding management of matrix after phenolisation.
Keep dry?
Bathe?
Topical antiseptic?
Dressing?
Phenolisation sticks? Any one have issues with these?

I have done a quick search and could not find answers. Apologies for reposting.

Thanks

 

To the best of my knowledge there is no international standard protocol although local arrangements may be in place. For what it is worth, I dress the area with inadine (non-adherent antiseptic dressing) and gauze. The dressing is changed after 3 days and the patient then encouraged to use hypertonic saline footbaths twice daily and re-dress with plain gauze. Once healing has taken place the footbaths and dressings need no longer be carried out.

Others may differ in detail, but for your own safety, I'd conform to whatever is the local procedure since if you did have the misfortune to be sued, whatever is the acceptable standard in your area would be what the court looks at.

All the best

Bill Liggins

 

Thats basically the process I used in OZ, but things may have changed for whatever reason

 

I have had experience with the phenolisation sticks...I presume you mean the EZ swab ones? I found the tip can be too big for certain PNA's and when 'breaking the seal' some phenol escaped out of the pod and onto my arm...rather painful and embarrassing in front of the patient!

 

Dovison R1, Keenan AM: Wound healing and infection in nail matrix phenolization wounds. Does topical medication make a difference? J Am Podiatr Med Assoc. 2001 May;91(5):230-3.


Abstract

After nail matrix ablation using phenolization, a medicated wound dressing (10% povidone iodine), an amorphous hydrogel dressing (Intrasite Gel), and a control dressing (paraffin gauze) were evaluated. Forty-two participants, randomly divided into three dressing groups, were evaluated. Healing time did not differ between the 10% povidone iodine (33 days), amorphous hydrogel (33 days), and the control dressing (34 days). For all groups, the clinical infection rate was lower than in previous studies, and there was no clinical difference between groups (one infection in the povidone iodine and control groups; none in the amorphous hydrogel group). However, in the amorphous hydrogel group, other complications, such as hypergranulation, were more likely. This investigation indicated that medicated or hydrogel dressings did not enhance the rate of healing or decrease infection rates.

 

i give the patient a dropper bottle of videne, a packet of plasters and instructions to soak in warm saline twice daily starting asap-i think the saline soaks are the key to the wound healing quickly

 

This is purely anecdotal but this is what I do

First dressing always heavy to create good barrier against bacterial ingress from outside and haemostatic deg inside to prevent any strike through - pt uses limbo foot shield for showering

bactigras soft paraffin direct to wound, then kaltostat sandwiched in tricotex (this prevents haemostat sticking to wound avoiding tearing when removing). then 5 layers sterile gauze alternating in direction then tube gauze and mefix strapping. Pt keeps on and dry for 2-3 days then attends for redress (looks like a Tom and Jerry bandage)

1st redress
dsg removed - providing no problems next dressing is melolin + sterile gauze x 3 tubegauze + strapping - so this dressing is a little lighter - again kept on and dry for 2-3 days

2nd redress
dsg removed - if healing to plan patient left to redress daily with light dressings after salt footbath

never had an infection - never had any post op pain in all those I have done - works brilliantly (SO FAR - TOUCH WOOD!!!!!!!)

 

Thank you all for taking the time to share your experiences.

Cheers