Advice on regrowth removal

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I have a patient who has had both 1st nails removed and phenolised twice and yet the nails have grown back. She has asked me to repeat the procedure. The nail plates are not complete or as thick as normal so the procedure should be less traumatic. Has anybody come across this and repeated the procedure? Any advice would be appreciated. Thanks.

 

Hi,
unfortunately these things happen, I have had regrowth on a couple of my patients, my advice to you would be to make really sure that the area under the eponychium is clean of blood and be as thorough as you can with the Qtip and phenol. I also know that some general surgeons perform the zadek's procedure (Matrixectomy) and then apply phenol, might be an option if you know of anyone in your area?? But just deal with the TNA as normal and be extra thorugh at every stage

Kayron

 

I agree that a Zadeks excision might be an option, but there is a case on record of an 18 year old professional footballer whose career was ruined due to osteomyelitis following phenol burn to the base of the distal phalanx in just such a case as you describe. I believe that this necessitated amputation of both halluces.

Carry out a Zadeks as an alternative to phenolisation, but please, not both.

All the best

Bill Liggins

 

Hello all,

One of the Podriatric surgeons locally sometimes performs a Winograd procedure for problematic ingrown nails.

I am unsure if general podiatrists are covered to complete this particular surgery? The surgeon I mentioned says we are although I admit I have not performed the procedure myself.

The post op' results I have seen are very good with no risk of regrowth.

Regards,

Mandy.

PS. I personally underwent a Zadeks procedure many years ago. Problematic nail regrowth meant I then had to undergo phenolic nail ablation 12 months later.

 

Had a mate who missed out on the Olympics due to Osteomyelitis after a Nail op. 10 years of training down the dunny.

No Idea of the procedure but it was his 3rd or 4th nail op.

 

You have just proven that Zadeks do not have 'no risk of regrowth'by your own experience.

All nail surgery has a risk of nail regrowth. Explore the literature and some are better than others. Worth reading.

Generally IMHO, technique is the key. Ensuring the matrix cap is excised in toto during a classic phenol matrixectomy procedure is the key to improving the efficacy of this procedure. Look for the small slither of non homegenous tissue akin to cartilage on the dorsal aspect of the matrix pocket and make sure this is curretted out.

My experience and those of others more experienced than I,

LL

 

Hi, You do not say if you carried out the procedure yourself or somebody else. In my practice the number of cases of regrowth of nail plate after a TNA is not great but it has happened sometimes. The questions I would ask are firstly how old is the phenol? It will deminish in potency with time specilaly if it is not stored in a dark bottle. If it shows any sign of a pink tinge it is too old for the job but will still burn so careful disposal is needed.Next for how long was the phenol applied to the area? In my experence at least one minute to one and a half minutes is ideal. A good gise is to continue until the tissue becomes white and then stop. I find the use of E-Z preloaded phenol cotten tips is very good. They enable the phenol to be placed just where it is required and avoids any overspill. As an aside I perform very few total nail avulsions as compared to partials. I remove only the portion that is causing the trouble and find that this works. Joseph

 

twirly,

unfortunately i contacted the society regarding insurance coverage for performing zadeks etc. The response was that certain procedures are being considered however at this time they ask us to refrain from performing the procedure.

 

Hi y'all,

I notice that there is a lot of mention about phenolisation and also surgical procedure but what about sodium hydroxide / acetic acid treatment? This is now being used in some PCTs as a viable alternative given that it ensures NO phenol headaches, can be used by pregnant staff, gives LITTLE or NO inflammation in the way of phenol, and has a faster resolution time. No phenol burns either although you have to take the same care using the sodium hydroxide. Not sure of its efficacy when used for regrowth though. Anyone have any further info on this?

Lisa

(ps Hi Bill Liggins - long time no speak!! )

 

Hi Yvonn

You perform phenol procedures and had some failures.
It happens - with ALL surgical procedures.

If you have mostly successes I would not worry about changing your protocol.
Just re-do the procedure.

As far as surgically excising the matrix PLUS using phenol - this is "bad technique". When an excision is done properly applying phenol will only increase your chance of complications. At no time, in no procedure and under no circumstances should phenol be applied to bone (which may happen here)

Good luck

Steve

 

Thanks everyone for your advice. It is much appreciated.