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Pt. has a reoccuring osteochrondosis/subungal exostosis 10 yo. This has been removed once 2 months ago another dpm wants to amputate the distal end of the hallux, I would like to try to remove the tumor and currette the bone to make a dell inthe bone, if so what incision would be best remove the nail and go through the nail bed or at the distal end of the great toe? Thanks for your help.

 

Hi M.E.

All depends on the location and type of "exostosis"

If it's at the distal tuft and more just an hyperostosis, a fish mouth incision is the preferred method through the distal end. It is much less painful then one might think going through the end of the toe, and does not interfere with the nail structures.

If it's further back, say mid distal phalanx, you can still use a distal approach but you need to get more dorsal and closer to the end of the nail plate. Be careful underscoring and just keep very close to the bone so as not to disrupt the nail structures. Some of these are quite large and protrude through the nail plate, in which case it's just easier to do a nail avulsion and go from there.

A distal Syme (amputating the end of the toe, usually half the distal phalanx) and taking the nail matrix with it is a very successful procedure as well. It leaves you a short, bald toe - the George Castanza of halluxes!

Hope that helps.

Steve

 

Thank you, that helps alot.