Hi All. In doing a nail resection around 5 weeks ago, something unusual happened with one edge. The other edge proceeded normally, had very little pain and has completed healing.
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When using a Black's file to agitate the cauterising chemical into the nail bed, after about 20 seconds, a particular stroke unleashed a strong 'blossoming' flow of blood from the wound. This was difficult to stop and ultimately I used AgNO3 to stem the bleeding. In a separate incident, the patient was bitten by a dog within the next few hours and was on IV broad spectrum antibiotics for a couple of weeks thereafter. Over the intervening weeks, the skin of the proximal nail fold and proximal part of the sulcus has remained swollen and painful, though it is not weeping and there are no gross signs of infection. The patient is a specialist medical doctor and is still taking pain relief for the wound.
Three days ago, I numbed the toe again and took a small additional stripe of nail away - without additional cautery. My thinking here was that: there may have been a small, whispy nail remnant poking into the healing tissue, there may have been a foreign body of some sort involved and, regardless of the mechanism of the problem, removal of some nail to allow the irritated flesh some respite from pressure should be a good thing. I am also aware that the blood flow so early in the two minute cautery process may well mean that the cautery will fail and the nail will regrow. If that were the case, I would have expected the wound to proceed normally for some time and then become a problem as the nail came through. I removed the nail piece but did not prowl around the site of the inflamed area as much as I probably should have, as the patient was becoming agitated.
Checking in today, three days post revision, she reports no change in the pain.
I think that the bleeding must be part of the problem as it would be quite the coincidence to have two unprecedented events occur if unrelated. I estimate that I have done about 1500 - 2000 NWRs without either event before.
So, where to from here? Would ultrasonographic imaging of the wound be useful? Would you adopt a wait and see approach for a bit longer? If not, what would be your next step?
Thanks in anticipation.
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