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Patient has had 4-5 bilateral, medial and lateral PNA's with chemical matricectomys...I did the last one with phenol - other practitioners did the previous ones - .... one lateral aspect grew back again -

I am thinking perhaps a procedure where we surgically remove the matrix at this point - any suggestions ????

Cheers
Canada Foot Gut

 

Its the variable that causes failure - in this case the variables are the phenol (old, out of date etc..) the surgical technique (incomplete removal of all matrix cells).

A wedge resection may be beneficial to avoid both variables above. Personally, after careful explanation to the patient about the risks and potential failures, I would try another office procedure with phenol first.

 

I think after 4-5 previous attempts of a PNA without the desired outcome, I would be discussing a possible referral to a colleague who is proficient at doing "sharps" procedures such as the Winograd etc. Or you could try doing the PNA procedure with phenol again - this time elongating your phenol exposure times to say 3 X 1 minute and using a curette to scrape away as much matrix tissue as possible. Good luck with your case.

Berms.

 

Hey,

You do not mention exactly how you perform this procedure. I have Michener students come through my clinic and I wonder at the wisdom of using a q-tip for phenol application. Are you using a coarse black's file? Curette? ORange stick? Let us know your method of phenol application, timing, are you agitiating the nail bed or the whole nail fold? And as mentioned how fresh is your phenol and how is it stored? just some thoughts. It is rare for someone to actually require Zadeks or Weinograd.