Phenol burns post-operativly

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Hello there

I am still a student pod, therefore have not had much experience on the post-op treatment of phenol burns (following partial nail matrixectomies). What do I do if my patient returns with phenol burns?!?! Do I redress the digit differently? Do I keep her coming back to me until the burns have completely healed?... Help! Please!]

Love me

 

Re: PHENOL BURNS

1. Chill.

2. Treat it as you would treat any other chemical or thermal burn. Non adherant dressings, silicone dressings like mepitel if you have them. If not, something like lyafoam with copious anaflex has always served me well.

3. See 1. I've seen many a toe have phenol end up on the skin. More times than I can count I've had phenol burn through my gloves and ended up with numb fingertips. Once I even had phenol splashed in my face. Never caused any problems or showed beyond a day or two. Although the phenol in the face one did increase my dry cleaning bill considerably (feeling it burning your face is quite a scary sensation)

 

Re: PHENOL BURNS

JaY
I agree with Robert, phenol burns/flare are common post op. Dressings are simple and the patient can use non-adherent dry dressings for as long as neccessary. The most important thing is to reassure the patient that this is very common, nothing to worry about and does not need antibiotics. I usually see the patient for a couple of follow ups and then let them contact me if they are worried. Rarely have I seen post op infection or complication, but until you have experience under your belt it can be a bit daunting as the toe can seem to look good initially and then take a turn for the worse!

Good luck with your studies

Cornmerchant

 

Sooner see some phenol burn than nail regrowth.....so would the pt after you explain it that way. It is awkward to get it where you want it and nowhere else, but I've never seen the signs of it last for long.
regards Phill

 

reduce the chance of getting a phenol burn by neutralising post-op with glycerol.

http://www.uq.edu.au/ohs/pdfs/phenolfirstaid.pdf

 

Blood proteins are pretty good phenol neutralizers as far as I know? if you've done your PNA so gently you don't get any you'll probably get regrowth anyway I would have thought?? but maybe I was taught wrong or was asleep for part of it??
regards Phill

 

Hi Jay,

I definately agree with the comments posted here.
Deep breath, and try to minimise the transfer of any anxiety (you may feel) onto the patient.
Be safe, and ensure that you understand the process of any therapy you are using.
And again, deep breath.

 

To reduce the risk of phenol burns I soak gauze swabs with chlorhexidine and place just below PNF and ID so any seepage is contained and can be quickly mopped up.
I also have a syringe of chlorhex on hand to quickly rinse any seepage.

you can try mopping any excess with cotton tipped applicators before rinsing, and using a syringe (needle-less obviously) to apply the rinsing solution to the nail bed will assist in getting the solution under the PNF and the in the sulci folds.

Other solutions can also be used. You'll find different clinicians have different preferences.

The most important things to remember are:
1)Dont use too much phenol initially.... you're not aiming to drown the nail
2) Rinse the nail bed thoroughly after the procedure, thereby reducing the risk of phenol remaining and continuing to burn the tissues.
3) Take a deep breath and stay calm if there is a seepage or burn - patients do pick up signals from you and react accordingly.
4) Admit if there is a burn that it was from the phenol, but that it can and will be treated without any fuss - patients respect honesty
5) Dress it as you would any other burn.

6) have a stiff drink that evening and put it down to experience :empathy:

........ and it will take a while for the nerves to go. I am fine now but the first procedure I watched I almost fainted, my first procedure I did faint, my first solo procedure once qualified I had sit for 20 mins after with coffee to calm my nerves and spent weekend waiting for phone to ring (we have give emergency contact number to patients for initial 24 hrs post-op).
You will be fine though

 

You should also discuss your concerns with your clinical tutor. It may be that your reported inexperience in this area may mean that you are not actually seeing a true phenol flare or phenol burn, just post-operative erythema & swelling.

Regrads.

Footsie 100

 

I find that if you mask the area using bactigras , this then enables you to reduce phenol burns down to a bare minimum. And is easily wiped clean after the wound is flushed with either IPA or IMS.

Snoozy

 

Hey Jay

I agree with Tkemp, have a stiff drink that evening :drinks.
Phenol burns happen and all you can do is to just dress and look after the nail postoperatively as best as you can. I always keep a piece of gauze at the base of the nail, just in case there is a spill or in case I dropped one too many drops of phenol.
I know you feeling anxious as we do not always see everything that is out there at varsity. But take a deep breath, it will be ok!

 

What he said!

Never heard of an unhappy patient because of a phenol burn.

Seen plenty unhappy patients because of regrowths!

 

I've used a 1/4 cc of cortisone ( Dexamethasone or similar ) behind the growth plate area...of course making sure it's not an infection...I use this when the patient has a chronic painful area back by the matrix after a permanent nail removal.

 

What would happen if the Phenol was not rinsed off and the toe was just bandaged. Patient reports burning sensation after numbness wore off forcing early removal of bandaging. How would subsequent treatment of burn differ from normal post-procedure care. No ointment? No soaking?

 

Settlement secured for child burnt with phenol acid during toenail avulsion