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Enhanced Removal of Phenol with Saline Solution Over Alcohol: An In Vitro Study
Damian Cordoba Diaz et al Dermatologic Surgery (online first)
Quote:
Background
Phenol cauterization is a chemical equivalent often chosen for treatment of ingrown toenails. Many reports describe intraoperative irrigation, or lavage, of the wound with various types of alcohol to neutralize any remaining phenol. There are conflicting reports in the literature as to whether true neutralization or merely effective removal of excess phenol is needed.
Objective
The aim of our study was to analyze the suitability and effectiveness of ethyl alcohol versus sterile saline when used in a lavage step after phenol application in the treatment of ingrown toenails.
Methods
We performed an in vitro study using human skin and a diffusion cell apparatus to measure the amount of phenol recovered after lavage with ethyl alcohol or sterile saline.
Results
When the wound was irrigated with ethyl alcohol, the total phenol recovered after two irrigation washes was 55.7% of the original amount initially used in treatment, compared with 80.4% when sterile saline solution was used for irrigation.
Conclusion
Alcohol and sterile saline solution do not neutralize phenol but dilute it and aid in its removal. We found that saline solution recovered more phenol than when washing with alcohol and recommend its use instead of alcohol for irrigation purposes after chemical matrixectomy.
Re: Saline is better than alcohol at getting rid of phenol
Since reading this thread in June I have been trialling flushing all my PNA's with Saline solution. So far, out of only a small sample of 4, it appears that the pain levels during the 1st review are reduced when using Saline flush. The worst of the 4 PNA's that I used saline on complained that it throbbed the first couple of nights and then had no pain but the rest stated that there was only minor discomfort or no pain whatsoever. I believe flushing with Saline solution will probably reduce post op pain of PNA's though I will continue to record client experiences for further validation.
Cheers
Brett
The Following User Says Thank You to brekin For This Useful Post:
Re: Saline is better than alcohol at getting rid of phenol
Havent we as a profession been doing this for over 10 years? With all respect to the article in the original post I believe its all been done before. The only concern flushing with alcohol is the lipophilic nature of phenol/alcohol and the fact it may spread and cause superficial tissue burns. Saline in copious amounts simply dilutes the phenol and moves it away from the site of application. I think in large enough quantities both would do exactly the same thing. The real question is why are we using phenol at all? Its carcinogenic when inhaled and I don't believe there are any studies in situ demonstrating that post nail/matrix resection that phenol application does what what the dogmatic textbook approach tells us it does. Happy for someone to post a peer reviewed research paper showing me though!
Re: Saline is better than alcohol at getting rid of phenol
Quote:
Originally Posted by pg2608
Great sample size? I look forward to your published research
Of course it is just anecdotal. I'm not saying that it definitely does reduce pain levels after operation. However when changing practice there's nothing wrong with keeping track of your patient experiences. The research already states, "When the wound was irrigated with ethyl alcohol, the total phenol recovered after two irrigation washes was 55.7% of the original amount initially used in treatment, compared with 80.4% when sterile saline solution was used for irrigation." It was an extrapolation that this may perhaps reduce post-op pain levels. Obviously extrapolations are not research but not all podiatrists have the time and numbers of PNAs to do a proper RCT. However, from an already disclosed very small sample size, I am so far happy with the results I've got. At the least it doesn't seem to increase post-op pain and there is a chance that it does reduce post-op pain levels.
Now if you can point to any good research articles that say that post-op saline flushing does not help reduce post-op pain then I am more than willing to change my practice to what the evidence supports.
Re: Saline is better than alcohol at getting rid of phenol
Quote:
Originally Posted by brekin
Now if you can point to any good research articles that say that post-op saline flushing does not help reduce post-op pain then I am more than willing to change my practice to what the evidence supports.
Saline irrigates the wound. Do it with saline, sterile IV solution, chlorhexidine, methylated spirits....I doubt the flushing agent has any effect on post operative wound pain. Logically how could it? The burn has already occured and as long as you are not liberally splashing phenol all over the tissue I fail to see how correct application could be assisted by variance in flush. It just makes no sense really.
Phenol is reported in the literature to be a slight analgesic agent though - so there may in fact be some evidence to suggest flushing it at all would increase post op pain.
At the end of the day, its a PNA - not life saving cardiac surgery. We are talking about regrowth options not mortality and morbidity options.
Re: Saline is better than alcohol at getting rid of phenol
Alcohol Plus Chlorhexidine is More Efficient Than Alcohol Alone for Phenol-Based Chemical Matricectomy: An In Vitro Study
Damian Cordoba Diaz , Ricardo Becerro de Bengoa Vallejo , Marta Elena Losa Iglesias , Manuel Cordoba Diaz Dermatologic Surgery; Early View
Quote:
Background
A phenolization approach is often chosen for treatment of ingrown toenails. Many reports describe lavage of the wound with alcohol to neutralize any residual phenol. The aim of our study was to compare the suitability and effectiveness of a solution consisting of alcohol plus chlorhexidine with that of alcohol alone in a lavage step during the treatment of ingrown toenails using a phenolization procedure.
Methods
We performed an in vitro study using human matrix and a diffusion cell apparatus to measure the amount of phenol remaining after various lavage washes. The effect of phenol evaporation was also examined.
Results
When phenol was irrigated with alcohol alone, total phenol recovered was 29.9 ± 4.8 mg (62.9% of the initial amount). When the phenol was irrigated with isopropyl alcohol plus 0.5% chlorhexidine, 39.8 ± 1.7 mg (83.8%) of phenol was recovered.
Conclusion
A lavage step including alcohol and chlorhexidine is more effective than alcohol alone for removal of excess phenol. The addition of chlorhexidine also contributed to inhibition of the action of phenol. This approach provides a suitable and effective means of diluting and removing any excess or residual phenol from the exposed area.
Saline is better than alcohol at getting rid of phenol
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