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Sharp debridement of NV lesions under LA - after effects of treatment

Discussion in 'General Issues and Discussion Forum' started by Paul_UK, Apr 17, 2012.

  1. Paul_UK

    Paul_UK Active Member

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    Hi, Ive had a search but can't find the answer to my question. For those that have debrided neuro vascular lesions under LA how have your patients been after the LA wears off? Have they found the lesion to be more tolerable and for longer or has it made things worse and more painful?

    Thank you
  2. wdd

    wdd Well-Known Member

    Hi Paul,

    I can't say about the situation using LA but I know from experience that without LA the patient is often in a lot more pain for up to a week afterwards.

    I think that the manipulation of the soft tissues during debridement makes it more painful immediately afterwards and that somehow the lack of 'protection' from the stratum corneum makes the exposed area extremely sensitive to the application of even minimal application of mechanical stress for as long as it takes for the str.corneum to thicken up sufficiently to 'protect' the area.

    My feeling was that even if the patient sat with the foot up and barefoot, ie absolutely no force being applied to the area, they would still suffer pain for the first 24 to 48 hours and that if as soon as they were suffering no pain with the foot up they loaded the lesion they would suffer more pain for a couple more days or so.

    Even with efficient and effective off loading of pressure they seem to suffer pain for up to a week. During that time they know where to point the finger!

    Little and frequent reduction seemed to offer the best outcome in terms of cut and come again chiropody.

    Electrosurgical destruction of the neurological and vascular element gives pain relief for at least one to two months, ie as long as it takes the destroyed nerve endings to regenerate and if during this stage and after the forces can be minimised or eliminated from the area it might be possible to extend the pain free period considerably (in theory up to the rest of their life) but don't bank on it.

    Good luck


  3. Ian Drakard

    Ian Drakard Active Member

    Hi Paul

    Haven't found the need to do this frequently, but the few cases I can think of generally had a marked increase in the tolerable duration between appointments.

    I think if the patient is finding pain level during treatment intolerable before I feel I have treated the lesion effectively I wouldn't hesitate to do this again. Kinder to the patient.

    Hope this helps
  4. Elizabeth Humble-Thomas

    Elizabeth Humble-Thomas Active Member

    Have treated many neuro vascular lesions over the years. Never used local anaesthesia. Take it slowly, pulling away from the lesion rather than pressing into it. I then apply Wp (wheat germ and pyrogallol ointment) to be kept dry for 48 hours. Perfectly tolerable, patient more comfortable immediately. If appropriate, u'd felt padding for a couple of days. Condition always improves, sometimes over months, sometimes years.
  5. bmjones1234

    bmjones1234 Active Member

    Would a Caustic Treatment work, gradual destruction of the tissue even when your not debriding?

    Also what exactly is the Wheat Germ Ointment?

  6. Elizabeth Humble-Thomas

    Elizabeth Humble-Thomas Active Member

    You could try breaking the lesion down with 60 per cent salicylic acid paste, I prefer to use WP ointment as it also seems to prevent pain for weeks at a time.
    Wheat germ is a source xof vitamin E, important for wound healing, and pyrogallol is an acid, rather rare and with some reports as a carcinogen in large doses. However, in the tiny amounts used here are negligible.
    I have used it on several patients with complex neuro vascular lesions for more than twenty years. Only one patient has had an adverse effect, causing some swelling and pain. If kept dry for the first 48 hours after treatment the ointment will leave a black stain on the skin until the next treatment.
    You would have to get it made up by a specialist pharmacy, it is very expensive, but a small amount lasts a very long time.
    If you in the old Pharmacopaeia for chiropodists by P J Read you should find the recipe!
    Hope this helps.

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