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I've been asked by my line manager why i prefer TNA's to b/PNA's. I have less regrowth and find it quicker so less stress for toe and patient. Any thoughts, thanks, mark

 

Very much agree, also the remaining nail after a bilateral may be too narrow to "sit" well or may be odd looking. But my number one reason for doing a total avulsion was that my patients were so critically limb threatened that I was only going to get one chance to clear the infection by removing the offending nail. Shelling off the entire nail much easier, less traumatic, rarely requires revision. To have made an incision into deeper tissue so close to bone may well have resulted in OM if they didn't already have it that is.
Ros

 

Working mainly in paeds, I've found that many parents and children appreciate the more 'normal' cosmetic result of PNAs. Most are willing to go down that road first, with the knowledge that a TNA might be required later. It's patient dependent.

 

The old saw in surgery is to do as little as needed to achieve the optimal result. Hence in this case, if a PNA will render the problem asymptomatic and there is no apparent likelihood of later problems, then a PNA is the correct surgery. However, in the instances noted above ie. in cases where other pathology is likely to cause later ramifications, or if a bilateral PNA is going to create a very narrow nail, then a TNA is the preferred option.

All the best

Bill Liggins

Dulce et decorum est, ut de propriis pedibus

 

When I taught nail surgery in various schools of podiatry, my maxim to the kids was not what you take off, but what you leave behind. If you have any doubts at all about the residual nail as an entity - a TNA is the way to go. Why are practitioners so funny about total nail surgery? It is a simple routine procedure, not a speciality as such.

 

I'm not funny about doing TNAs at all. I think both procedures have their place. My opinion is just that PNAs shouldn't be discounted outright.

 

If only one side is affected why would you take the whole nail?
Agree that cosmetics play a roll in what people decide to do, if its a woman very hard to convince her you want to remove her whole nail.

 

Thanks all, will discuss the responses at our next meeting, mark

 

Unless extreme case, always go for PNA first. The nail serves a purpose, and to totally remove it leaves the toe exposed. Also, except in very elderly patients who rarely show their feet, the cosmetic effect can be very upsetting, in men as well as women.