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Rate of regrowth following pna without phenolisaton

Discussion in 'General Issues and Discussion Forum' started by magda66, Nov 11, 2009.

  1. magda66

    magda66 Active Member

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    Hi there
    A terminally ill man with chronic (1.5years+) painful onychocyptosis and hypergranulation was referred to me by a community nurse. He is unable to attend clinic for pna and as a palliative treatment,i’ve agreed to do the procedure without phenol at his home. He has good peripheral circulation just now but i don’t want to increase the risk of infecton and delay healing time for him and discussed this iwth his gp who agrees
    My questons -how long does it usually take for a nail to grow back enough to become problematic again?
    The community nurses are dressing and monitoring the toe and i have arranged to see him again in 4 weeks/sos. Is this soon enough?could it have grown back into the pnf by then? i have not done nail surgery without cautery before.
    its also my first time doing nail surgery in a domestic envriornment but i think to making the man more comfortable is more important than the ideal environment? any comments or advice please
    Thank you
    Mayre collins
  2. It really depends on granulated tissue around the nail. If you can remove a lot of the thickened, calloused granulated tissue and it does not return your chances of having less problems increase. As you said he has painful onychocyptosis and hypergranulation it could become painfil very quickly. As for the 4 weeks it depends on the patient. It might be good to pop in after 1 week or at least get msm photo´s from the nurse sent to your mobile incase something looks funny to you you can see him again.

    Good luck and hope the patient heals well for you
  3. drsarbes

    drsarbes Well-Known Member

    PNA without the phenol!

    Well, actually it's P&A which is Phenol and Alcohol - if you perform this without using Phenol it's an I&D - Incision and Drainage.

    If you remove a nail completely it usually takes about 8-10 months to re-grow fully. If you remove a boarder completely it will take the same amount of time to re-grow (since nails grow proximal to distal not side to side)

    How long this patient will get relief from an I&D depends not only how quickly the portion of this nail re-grows but where it is ingrown (proximally, distally, etc....)

    I good I&D will normally give a patient predisposed to recurrent infections relief for at least four months.

  4. I was taught that its partial nail avulsion and full nail TNA is total nail avulsion intersting the difference between countries
  5. drsarbes

    drsarbes Well-Known Member

    P&A and I&D makes a bit more sense, don't you think?

    Avulsion, partial avulsion.........
    To my way of thinking this is like being pregnant or partially pregnant.
    Regardless of the semantics, was your question answered?

    Last edited: Nov 11, 2009
  6. JB1973

    JB1973 Active Member

    hi there
    i have carried out nail surgery in patients houses or nursing homes a few times. as long as you can make the field as strile as possible with drapes etc and follow your normal aseptic procedures then it should be fine. i've certainly never ahd any problems (touch wood!)
    if i was you i would take the whole nail off. it would be easier and quicker as you might not be able to get the patient into as good a position in his home as you would in clinic. i would also consider again using phenol although i can understand the reluctance.
    good luck
  7. magda66

    magda66 Active Member

    thankyou i used AGNo3 last week to try to reduce the hypergran its reduced considerably but not enough to remove spicule so i wil proceed with pna this week. that's a good tip about the photo's and i would have planned to call in the following week but he's private patinet and has nurse calling anyway whihc he doesn't have to pay for.
  8. magda66

    magda66 Active Member

    yes steve thanks for your advice on regrowth rates. i also understood pna to mean partial nail avulsion.
  9. Following partial avulsion or total avulsion for painful ingrown or gryphotic toenails, I prefer the matrixectomy technique of sodium hydroxide 10%/acetic acid 5% technique, curettage of the matrix : 3 or 4 10-15 sec sequences of NaOH - acetic acid - dry - repeat. Quite caustic and time sensitive generally. Less drainage and shorter healing times generally than phenol (which I originally trained with); our recurrence rate with NaOH around 5% over past 24 years.
  10. markjohconley

    markjohconley Well-Known Member

    I'm with the "partial nail avulsion" ("total nail avulsion") lobby, and what if phenol isn't used??
    partial or total describes just that
    the I&D makes sense,
    yours truly,
    the antipodean liberal

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