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Sodium Hydroxide

Discussion in 'General Issues and Discussion Forum' started by kooky, Nov 29, 2011.

  1. kooky

    kooky Member

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    Can anyone can help on details of the application of sodium hydroxide as a substitute for phenol following partial nail avulsion.

    I have tried to access the search facility but cannot view anything.

    I am interested in any journal articles and advice on how to apply, for how long, in what form is it applied and does it require neutralisation?

    Many thanks
  2. Brummy Pod

    Brummy Pod Active Member

    There was an article about it in the British Journal of podiatry a few years ago. I'm sure that Huddursfield hospital is where they obtained the NaOH from. I'll see if I can find the article for the protocol.
  3. deveron

    deveron Member

    Chemical matricectomy of nails. Goldberg LH, et al. Dermatol Surg. 2010

    Retrospective comparison of experiences with phenol and sodium hydroxide in the treatment of ingrown nail. Tatlican S, et al. Dermatol Surg. 2010

    Chemical matricectomy with 10% sodium hydroxide for the treatment of ingrown toenails in people with diabetes. Tatlican S, et al. Dermatol Surg. 2010

    Comparison of phenol and sodium hydroxide chemical matricectomies for the treatment of ingrowing toenails. Bostanci S, et al. Dermatol Surg. 2007

    Sodium hydroxide chemical matricectomy for the treatment of ingrown toenails: comparison of three different application periods. Kocyigit P, et al. Dermatol Surg. 2005

    A prospective randomized comparison of the Zadik procedure and chemical ablation in the treatment of ingrown toenails. Shaath N, et al. Foot Ankle Int. 2005

    Chemical matricectomy with 10% sodium hydroxide for the treatment of ingrowing toenails. Ozdemir E, et al. Dermatol Surg. 2004

    Ingrown toenail relief drug products for over-the-counter human use. Final rule. Food and Drug Administration, HHS, et al. Fed Regist. 2003

    Results of partial matrixectomy for chronic ingrown toenail. Kayalar M, et al. Foot Ankle Int. 2011

    Matricectomy and nail ablation. Baran R, et al. Hand Clin. 2002

    Chemical matrixectomy for ingrown toenails: Is there an evidence basis to guide therapy? Espensen EH, et al. J Am Podiatr Med Assoc. 2002

    Improved healing with a collagen-alginate dressing in the chemical matricectomy. Van Gils CC, et al. J Am Podiatr Med Assoc. 1998

    Ingrowing toenails: studies of segmental chemical ablation. Gem MA, et al. Br J Clin Pract. 1990

    Phenol and alcohol chemical matrixectomy. Burzotta JL, et al. Clin Podiatr Med Surg. 1989

    Toenail avulsion. Thornington MJ, et al. Can Fam Physician. 1983
  4. kooky

    kooky Member

    Thank you for the information provided.

    I have managed to locate and view five journal articles, all very helpful.

  5. footboy25

    footboy25 Member

    1 minute application is the best from what I've read
  6. kooky

    kooky Member

    Thank you Footboy.

    I have used the Sodium Hydroxide on a lady who was allergic to Phenol.

    The procedure took place three weeks ago, applied for 1 minute and to date everything looking good. She has had no post-op pain or discomfort and the area is healing well.

    Would definitely use again.

  7. footboy25

    footboy25 Member

    That's what I do for my matrixectomies..glad you liked the procedure
  8. Beccapod

    Beccapod Member

    Hi there Footboy,

    just to clarify you use Sodium Hydroxide for just one minute, or three separate 1 minute applications as with Phenol?

    Since these nail surgeries (above) were performed some time ago, have you since come across any problems in using Sodium Hydroxide rather than Phenol?

    Many thanks,

  9. JoelD

    JoelD Member

    I used Sodium Hydroxide for many years in practice preferring it over phenol. I applied 3 applications at 20 seconds per applications (total 1 minute) then irrigated the nail fold with water. The inflammatory reaction with NaOH was not a severe as phenol. The nail folds did not drain as much. With NaOH, in general the nail folds were pretty dry around the 2nd week for a partial matirxectomy. On occasion I had a patient that would have a greater inflammatory response than was typically expected. I had a few patients with a minimal if any inflammatory response. My observation in general was that teenagers and younger had more of an initial inflammatory response than middle aged and older patients. The overall healing time did not seem affected although the younger patients may have healed slightly faster.

    I successfully used NaOH on many diabetic patients that I never would have considered using phenol on. Some of my diabetics took some extra time to heal as expected. I never had any serious complications. You need to exercise good judgment on who can tolerate the procedure.
  10. Beccapod

    Beccapod Member

    Hi JoelD,

    thanks for your post.

    Having used phenol for the past 12 years, I am now eagerly awaiting my first patient to try sodium hydroxide on.


  11. JoelD

    JoelD Member

    Hi Becca,

    One thing you need to be a little careful about is when doing matrixectomies in both the medial and lateral nail folds at the same time on the same toe. Normally it is not a problem. However, occasionally, you will have a patient with the central portion of the nail that is not well adhered to the nail bed. They may have come to you this way or it could be caused when doing the medial and lateral nail avulsions. Either way be cautious of this. I have put NaOH in the medial and lateral nail folds and instead of having a partial matrixectomy in each nail fold I got a total. The entire nail matrix died. This happened to me 3 or 5 times over a 10 year period. I never had this problem when the nail was adhered centrally using NaOH. Apparently disruption of the nail bed/proximal nail fold allows the NaOH to capillate under the nail fold with a small amount being effective in destroying the central portion of the nail matrix. I did thousands of nails with phenol previously never having this problem, although I sure it can happen with phenol too.

    My solution was twofold. Complete the avulsion doing the matrixectomy another day or place my thumb on top of the nail/nail fold squeezing the toe so as to press the nail plate to the nail bed. While doing this I would apply the NaOH subsequently irrigating the area very well. I made sure no NaOH was able to capillate to the central portion of the proximal nail fold. This seemed to solve the problem. My advice would be, if possible, complete the avulsion and then do the partial matrixectomies when the nail starts to regrow. I suppose you could always use phenol as a third option, but I stopped keeping phenol in the office since I did not use it anymore.

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