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3 x 1 minute applications of phenol, do you advise flushing after each minute application or after completion of applications? Also, alcohol or saline solution? After reading some threads, I am confused. (This is quite normal for me so don't worry too much)
This is my first post, so please be gentle.
Thanks,
Yvonne
I do 2-3 minutes worth of working phenol through the matrix site with a curette.
If good vascularity and otherwise no healing concerns - no flush. Just let it bleed.
If vascularity is compromised, or patient is elderly, just a quick flush with saline at the end.
Not sure why alcohol is still promoted as a flush...it doesn't actually 'neutralise' the phenol. Blood or saline will dilute the concentration sufficiently in most cases.
LL
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I was taught that flushing with anything following application of phenol was not required as phenol is a self-limiting caustic. Patting the area dry with sterile gauze after 3 min application so that there wasn't excess phenol in the sulcus is all that is required...?
I was taught that flushing with anything following application of phenol was not required as phenol is a self-limiting caustic. Patting the area dry with sterile gauze after 3 min application so that there wasn't excess phenol in the sulcus is all that is required...?
Ditto.
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Dear Yvonne:
Alcohol is simply a solvent of phenol to prevent further spread of the same damage to surrounding tissues.
Saline could be used equally to reduce the concentration of caustic used.
I use alcohol, but to implement it using a trigger spray, similar to that used in gardening, but metal container.
This allows me to fine jet flushing with high pressure, with significant savings of alcohol (not their value, if not so wet) and ease of application.
Other colleagues used a syringe to the application, but is complicated and cumbersome.
If you use needle prick also unnecessary danger.
I hope my recommendation will be helpful.
Sincerely:
Jose Antonio Teatino
Professor of Surgery
The Academy Ambulatory Foot & Ankle Surgery
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Saline neutralises phenol, there is a controversy on when to use it as some believe (undocumented) would reduce the effect of phenol on the nail matrix. alcohol flush on the other hand decreases the concentration of phenol (as phenol and alcohol has the same functional group OH) and hence decrease excessive tisse damage.
Dear davsur08:
I should not have to explain it.
Phenol causes a chemical burn with direct application to the skin.
Once the damage caused in the skin, no alcohol or saline decreases the damage caused.
To avoid damaging nearby tissues usually use vaseline (for its barrier effect), but to terminate the application of phenol, it is removed.
That is why using a solvent used to remove phenol and prevent further cauterizing tissues, which are now unprotected without Vaseline.
To use the word "neutralize" should know exactly the chemical reaction that is caused by linking the two products, and new product obtained with the mixture.
Also the characteristics of the resulting product is not caustic.
It's something I personally know, and therefore I can not report.
Require consultation with a chemical.
If I can ensure that salt and alcohol are solvents, and wash them, they are going to remove residual phenol.
This is the real reason for their use.
I insist: Saline or alcohol may be used interchangeably.
Sincerely:
Jose Antonio Teatino
Professor of Surgery
The Academy Ambulatory Foot & Ankle Surgery
HI Yvonne! I am sure you have enjoyed everyones posts and have realised that we are all the same but oh so different. Personally I use saline to flush after I am done with my phenolization. Although as students we were taught to flush with alcohol.
Good luck with making up your mindhttp://www.podiatry-arena.com/images/smilies/dizzy.gif
Dear Charlie:
I also deleted the intermediate washing, using the continuous application for many years.
I get similar result, but a more comfortable.
Best regards:
Jose Antonio Teatino
Professor of Surgery
The Academy of Ambulatory Foot & Ankle Surgery
I am still surprised that Phenol is still being used after all these years with the high incidence of slow healing, prolonged drainage and tenderness. I also would Never do a phenol procedure on a patient that is vascularly compromised (or use a tourniquet around the base of the toe on them).
I firmly believe sodium hydroxide is superior to Phenol and can be directly neutralized by acetic acid (white vinegar used on salads). Rarely do I see prolonged healing, redness, drainage or tenderness. I also apply a gauze saturated with acetic acid on the toe after the procedure. Also, during the procedure, I will manually hold a Penrose drain around the base of the toe and pull on it just enough to provide hemostasis. Many make the mistake of clamping on a tourniquet much too tight which can very well cause damage to the vessels, especially in the elderly.
If your allowed to do sharp dissection (Suppan procedure) in the UK, I think that is by far the superior way as you are directly resecting the nail matrix and not leaving behind chemically burned matrix cells. A little Neosporin ointment and wet to dry saline dressing changes BID, and healing is rapid, post-op infection rare, and no adverse chemical reactions.
To use the word "neutralize" should know exactly the chemical reaction that is caused by linking the two products, and new product obtained with the mixture.
Also the characteristics of the resulting product is not caustic.
It's something I personally know, and therefore I can not report.
Dear Colleagues,
thank you for pinting it out, Dr. Teatino. Neutralise is not the word, Solvent.
eventhough phenol is a carboxylic acid and NaCl is basic, the reaction is not a Neutralisation as NaCl in water produces NaOH + H2 + Cl2.
H2 and Cl2 being in a molecular state would not enter in to reaction whiel NaOH would split in to Na+ and OH- and Phenol would C2H5+ an OH-. hence the overall reaction would result in no new product and same is the case with alcohol(C2HOH). (other words saline or alcohol would reduce the concentration of phenol and therby lowering its action)
Since ive used a WRONG word to describe the reaction i thought i owe every one an apology and an explanation.
Kind regards
David
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I firmly believe sodium hydroxide is superior to Phenol and can be directly neutralized by acetic acid (white vinegar used on salads). Rarely do I see prolonged healing, redness, drainage or tenderness. I also apply a gauze saturated with acetic acid on the toe after the procedure. Also, during the procedure, I will manually hold a Penrose drain around the base of the toe and pull on it just enough to provide hemostasis. Many make the mistake of clamping on a tourniquet much too tight which can very well cause damage to the vessels, especially in the elderly.
Steven
I absolutely disagree with the above statement. When I last worked in the NHS some six years ago, the PCT had been using sodium hydroxide for nail ablation for over two years. There was a marked increase is post operative pain and discomfort, delayed healing and an increase in the regroth rates. Thankfully, after a surgical audit, they reverted to using phenol. From recollection, it was the risk to the operator from inhalation of the phenol fumes from multiple procedures in a session, that was deemed 'high risk' and led to the change in the first place. When they reverted to phenol, the problem was overcome by having adequate ventalation/fume extractor in the day theatre where the procedures took place. This morning, I completed my 2,400 partial nail avulsion and phenol matrixectomy without any complications sinceI graduated in 1983. I don't flush with alcohol or saline generally and I protect the periungual tissues with some petroleum jelly during preparation.
All the best
Mark Russell
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Flushing after phenol
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