Post PNA blues

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Can anyone assist with this interesting case??

Case:
19year old female with no medical history and past IGTN's.
Bilateral PNA's performed on both hallucies which have resolved with no spikes or regrowth present. Patient presented 5 months post op with non painful swelling and redness from the proximal nail fold to the IPJ L>R. She has a possible mild fungal infection of her left toenail

I tried to drain the fluid, however there was no fluid just heavy bleeding from the sight.

It appears as chronic paranchia, however there is no pain or exudate. I have tried a mixture of elocon cream to the sulci and antifungal paints to the nail on the last visit, however feel this isn't the answer.

Has anyone seen this before and if so knows how to treat it? Web research has not helped me at all.

Regards,
The Caulfield Team

 

Inclusion cyst?

 

Hi Caufield Team,

Maybe test for a staph infection... we have had a similar case with a young pt who had chronic infection prior to surgery.

 

send a swab for culture.

 

I have seen this a number of times, and the non-painful swelling and redness will eventually become painful. In each case, it was an inclusion cyst, as someone else mentioned.

Under local anaesthesia and a tourniquet, you can incise the area and remove the hard white fibrous unattached nodule you will find (like a pearl in an oyster), and the condition will resolve.

 

You Also May Want To Take An X-ray Rule Out The Possibilty Of Osteo

 

Could she have retraumatized the area?I have not seen this too often,but a C&S may help.

 

Hi Katie,

Did you get to the bottom of this case?

If not, in my experience (having done literally thousands of these procedures over nearly 30 years), another reason for this can be that the nail fragments or splits if during the original procedure the beaver is not inserted true to the cut line made by the nail splitter thus leaving a spur of nail that haemorrhages the tissue.

Under LA use a blacks file or currette to probe. It can be difficult to locate the spur due to the inflammation and swelling. When found, use tissue nippers to excise.

Regards,

Peter Norton
Body Clinic
Jl. Prapanca Raya No. 37
Kebayoran Baru, Jakarta Selatan
Indonesia
Tel: +62 21 72783827

 

I Just Was Wondering If The Problem Went Away? All The Answers Given Could Be Correct I Would Think An I&d Would Answer The Question.

 

I was just wondering why HJM begins every word with an upper case letter? Quite an unusual affect!

 

No I do not start every word with a capital not even sure how that happened