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Phenol reaction?

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  #1  
Old 29th April 2008, 10:07 PM
Berms Berms is offline
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Default Phenol reaction?

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Hi folks,
Have done probably 150 or more nail procedures/surgeries in the last 5-10 yrs, haven't had any real adverse reactions or complications so far.

However, I did a partial nail avulsion and chemical cautery (with phenol) on the left Hallux nail of a healthy 12yr old. She had no reported allergies and no regular medication... She is complaining of a lot of pain post-op (4 days) and has a large "white area" (her words) around the wound site? The original phenol was flushed with alcohol and the toe was dressed with povidone iodine ointment. She has been redressing herself since day 3.

She is coming in today for me to have a look, but I thought I might get an idea of what I might be looking at? I have had some phenol reactions before, but they are usually small and red in colour.

Any advice is appreciated.
Adam
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Old 29th April 2008, 10:33 PM
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Default Re: phenol reaction?

Hi Adam,

If the dressing has become wet the area may just be macerated.

I believe the chemical action of Phenol causes a burn. Therefore, it is likely the wound would create an amount of fluid during the initial healing process.

I've known patients try to shower with a bag over the foot to keep dressing dry but this rarely works & if she hasn't changed the dressing that may be the problem.

Be interested to know how she gets on.

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  #3  
Old 30th April 2008, 12:26 AM
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Default Re: phenol reaction?

Adam
There is little point in speculating as her description could mean anything- hopefully you will post back when you have actually seen the toe.

Regards

Cornmerchant
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Old 30th April 2008, 01:47 AM
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Default Re: phenol reaction?

Quote:
Originally Posted by cornmerchant View Post
Adam
There is little point in speculating as her description could mean anything- hopefully you will post back when you have actually seen the toe.

Regards

Cornmerchant
Thanks cornmerchant - will do.
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Old 30th April 2008, 02:51 AM
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Default Re: Phenol reaction?

UPDATE: -

Pt returned with significant maceration adjacent to surgical site and some yellow exudate that indicated a likely infection.

I debrided the macerated tissue, cleared the wound site and it looks much better. I redressed and advised more regular changes of the dressing (twice daily or prn) and I also suggested a return to the GP to discuss a stronger or alternate antibiotic.

Have I missed anything?

Thanks
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Old 30th April 2008, 03:10 AM
W J Liggins W J Liggins is offline
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Default Re: Phenol reaction?

If the exudate is whitish/yellow, then the most likely causative organism is staph. aureus. However, you never know; it's always worthwhile sending a swab for C & S.

All the best

Bill Liggins
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Old 30th April 2008, 03:38 AM
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Default Re: Phenol reaction?

I will usually advise my patients to soak the toe in salt water solution for 7-10 days post-operatively in conjunction with daily dressing changes. I also ask them to avoid touching the wound as this can often increase the likelihood of an infection. It is also important they keep their dressings dry. Bear in mind, that sometimes pts can irritate the wound when they remove there dressings as they sometimes have a tendency to adhere to the wound site.

It sounds to me, like you are doing everything correctly. Just make sure that the patient is following your instructions properly.

Regards,

Daniel
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Old 30th April 2008, 04:10 AM
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Default Re: Phenol reaction?

I used glycerol routinely to minimise risk of phenol flare when I used to do nail surgery
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Old 30th April 2008, 05:23 AM
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Default Re: Phenol reaction?

Adam
Thanks for the update - glad it is pretty straight forward.

I was interested in Daniels protocol as this is the same regime that I trained with. However, a couple of years ago I read an interesting article- cannot for the life of me remember where at this moment- but it recommended treating the nail op site as normal from the following day ie get wet in shower and apply dry dressing daily. Since changing to this protocol I have found that healing time is greatly reduced and the site has less soreness afterwards. Patients have been able to get back into normal shoes very quickly. I have now droped saline foot baths completely.

Regards

Cornmerchant
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Old 30th April 2008, 05:26 AM
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Default Re: Phenol reaction?

Quote:
Originally Posted by cornmerchant View Post
Adam
Thanks for the update - glad it is pretty straight forward.

I was interested in Daniels protocol as this is the same regime that I trained with. However, a couple of years ago I read an interesting article- cannot for the life of me remember where at this moment- but it recommended treating the nail op site as normal from the following day ie get wet in shower and apply dry dressing daily. Since changing to this protocol I have found that healing time is greatly reduced and the site has less soreness afterwards. Patients have been able to get back into normal shoes very quickly. I have now droped saline foot baths completely.

Regards

Cornmerchant
anecdotally, my wife had partials done, and she didn't bother with the saline soak either, and she healed uneventfully in 2 weeks
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  #11  
Old 4th May 2008, 05:14 AM
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Default Re: Phenol reaction?

Quote:
Originally Posted by Peter View Post
I used glycerol routinely to minimise risk of phenol flare when I used to do nail surgery
Hi Peter, can you expand on this a little?

Thanks, Adam
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  #12  
Old 4th May 2008, 03:47 PM
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Default Re: Phenol reaction?

much like using glycerol i know of a number of people who place bactigras around the eponychium to prevent phenol burns etc
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  #13  
Old 4th May 2008, 10:33 PM
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Default Re: Phenol reaction?

Quote:
Originally Posted by cperrin View Post
much like using glycerol i know of a number of people who place bactigras around the eponychium to prevent phenol burns etc
I mask the surrounding area with the wax from the bactigras and it works great to stop phenol getting everywhere, then use the bactigras as a drain for the site before dressing. Everything comes out nicely then when I take dressings down a couple of days later. Have sene a couple of cases from collegues where a phenol burn has occured because it has gotten out of the sulcus and onto the toe, and I've seen those burns present white, especially if it's under dressings and has become mascerated.

I've always been under the belief that as phenol is such a strong chemical, and used quite extensively as a cleaning agent/disinfectant, it should just about kill any bugs which should happen to be in the site of surgery (given that the toe isn't already infected). Any post op infection that I've come across ususally can be traced back to patient self care (or lack of in some cases!) of the site and trying to keep it clean and follow foot bath and dressing practices. With my patients, I will issue a dresing pack with some saline, betadine, cutiplast and specific dressing instructions when I take dressings down, so hopefully they will do the right thing.

Thanks for an interetsing discussion post!
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  #14  
Old 12th May 2008, 12:00 AM
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Default Re: Phenol reaction?

Glycerol/glycerine is well known to neutralise phenol burns.

follow the link

http://www.uq.edu.au/ohs/pdfs/phenolfirstaid.pdf

Last edited by Peter : 12th May 2008 at 12:11 AM. Reason: added link
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Old 12th May 2008, 04:54 AM
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Default Re: Phenol reaction?

Quote:
Originally Posted by Peter View Post
Glycerol/glycerine is well known to neutralise phenol burns.

follow the link

http://www.uq.edu.au/ohs/pdfs/phenolfirstaid.pdf
Surely it is only a decontaminent, which is the main reason why there is the big debate now about the use of sodium hydroxide which actually can be neutralised and the research into radiolase

chris
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Old 12th May 2008, 06:51 AM
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Default Re: Phenol reaction?

Hi Berms:
Reading the posts here. I wouldn't get overly concerned. As you know these do heal as a burn heals. I have seen so many of these with a small amount of "yellowish drainage" that I don't get to surprised anymore. Have her soak (any astringent) gently wipe any drainage away (so as not to crust up and block further drainage) and use a little antibiotic cream (your choice) air it out when she can and cover with a bandaid when wearing shoes.



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Old 12th May 2008, 10:44 AM
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Default Re: Phenol reaction?

Hi Berms

Sounds like infection and agree with what has already been said, but i have also seen this this reaction to iodine. Was just a thought!

chris
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Old 12th May 2008, 06:50 PM
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Default Re: Phenol reaction?

Berms

Phenol (80%?) is a caustic and will ulcerate the skin (burn). It has an almost immediate effect and whilst alcohol or organic tissue will neutralise it, the white slough is frequently seen where there there is accidental spillage. One technique reasonably popular was not to neutralise the phenol with alcohol and let the returning blood supply do it. No RCT to verify outcome but the incidence of phenol burns would most probably have been higher. Routine antiseptic policy post operation would in healthy individuals have a complete success (but the patient may report some post op pain).

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Old 13th May 2008, 04:32 AM
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Default Re: Phenol reaction?

Quote:
Originally Posted by drsarbes View Post
Hi Berms:
Reading the posts here. I wouldn't get overly concerned. As you know these do heal as a burn heals. I have seen so many of these with a small amount of "yellowish drainage" that I don't get to surprised anymore. Have her soak (any astringent) gently wipe any drainage away (so as not to crust up and block further drainage) and use a little antibiotic cream (your choice) air it out when she can and cover with a bandaid when wearing shoes.



Steve
Thanks drsarbes, in hindsight I think this is exactly what happened. I mistook the yellowish drainage for infection when really it was probably just wound exudate and normal tissue healing process. I advised on regular salt water foot baths and twice daily dressin changes in the initial 2-3 weeks.

UPdate - the wound has completely cleared, there is no residual pain and the toe looks great.
Thanks all for your valuable advice.
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  #20  
Old 13th May 2008, 04:35 AM
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Default Re: Phenol reaction?

This is one of the best things about Podiatry-Arena, advice, giving it and getting it.
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Old 13th May 2008, 06:51 AM
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Default Re: Phenol reaction?

Anytime.

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Old 23rd April 2010, 12:36 PM
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Default Re: Phenol reaction?

Interesting reading. I've just had a case of suspected local phenol burn after a PNA. The patient has seen her GP who suspected infection and is now on antibiotics. She has now deveolped headaches, sweats etc. She's two weeks post op. Phenol was applied for 3 x 30 secs. I realise it could be a systemic/ viral infection but also wondered if anyone has seen a case of phenol poisioning after a PNA. I'd appreciate any feed back.
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  #23  
Old 23rd April 2010, 01:45 PM
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Default Re: Phenol reaction?

Wellpod

From experience I would hazzard a guess that the patient did not have an infection but purely phenol flare which is very common. Gps are not familiar with this and mistake it for infection. I suspect the headaches and sweats are probably psychosomatic . I once had a patient who would not be convinced that the TNA was healing normally and she took herself off to the GP for antibiotics-she also was "very ill" and loves to relate the saga to anyone who will listen. Unfortunately she told her orthopoedic surgeon how awful it was so you can imagine how that made me feel! As it turns out she has one of the neatest results I have achieved!

I am pretty certain that phenol can only act locally and have never heard of it causing infection or poisoning, quite the opposite in fact. Hope it all works out ok.

Cornmerchant
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Old 23rd April 2010, 02:33 PM
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Default Re: Phenol reaction?

Thanks for your feed back Cornmerchant. I've seen the patient again this morning and it certainly looks like a local flare and is now settling well. She also has a bad cold!
Thanks again.
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