Podiatry Arena members do not see these ads

All,

One of my colleagues is looking at the efficacy of chemical agents in matrixectomy procedures - post-operative pain, healing times, regrowth rates - in particular, comparing the use of phenol and sodium hydroxide. I know Ian Graham in New Zealand presented a paper some years back but does anyone know of recent quality research that has been peer reviewed?

Thanks for your assistance.

Mark Russell

Tweet

Share

Hi Mark,
Not sure on chemicals, but there was a poster presentation at the SoCaP conference on electrodessication as an alternative to phenolisation which might be of interest to you.
The lead author was someone called Ramzana Anwar from Manchester. Can't remember the contact details, one of the PCT's around manchester I think. Also can't recall the subject numbers, although it should be published in the BJP. Sorry about forgetting, I was so chuffed about remembering that Amin Sain post on the mailbase too!

Hello again,
Trying to make up for my rapidly depleting brain cells (damn you bourbon!) here's a link to a paper in the American Society of Dermatology Surgery's journal -
http://www.blackwell-synergy.com/lin...4.30004.x/abs/

And for phenolisation -

Bostanci S, Ekmekci P, Gurgey E. Chemical matricectomy with phenol for the treatment of ingrowing toenail: a review of the literature and follow-up of 172 treated patients. Acta Derm Venereol. 2001 Jun-Jul;81(3):181-3.

There are many options for the treatment of ingrowing toenail, ranging from simple conservative approaches to extensive surgical procedures. Although conservative treatment modalities are helpful in patients with stage 1 disease, stage 2 and 3 ingrowing toenails are best treated surgically. The aim of this study was to evaluate the efficacy of chemical matricectomy with phenol for the treatment of ingrowing toenail. A total of 350 phenol ablations were performed on 172 patients with stage 2 and 3 disease. Each patient was reviewed weekly until full wound healing was achieved and afterwards, to assess the long-term efficacy of the treatment, they were followed up for a mean period of 25 months. The healing period after the operation ranged from 2 to 4 weeks and no postoperative complications were seen. Only two recurrences (0.57%) were observed, after 9 and 17 months, respectively, and nail spikes had developed in only two toes (0.57%). The success rate was found to be 98.8%. We conclude that phenol cauterization is an excellent surgical method for the treatment of ingrowing toenail because of its simplicity, low morbidity and high success rate.

There are a number of small scale studies which have been published but in terms of good quality evidence this is still a grey area.

i have been performing mechanical matrixectomies using a minimal incision technique via a halliport burr.thus achieving a complete debridement of the matrix on both borders without the need of any chemicals.my recovery period is less than a week and i don't have to worry about any chemical burns.no pain meds needed.

I would be most grateful if you would explain this technique as it is an approach that I am not familiar with.

Regards

Stephen

__________________
'There are no problems - only opportunities to be creative' :)

hi stephen,

surgical matrixectomies such a winnograd or a suppan procedure are nothing new.however with the mis nail matrixectomy , the affected nail particle is avulsed in the usual manner.then ,an incision into the affected nail fold is made with a #67 blade until you reach the osseous surface between the matrix and bone,then using a high torque surgical drill such as an ossada,you introduce an alliport surgical burr,you may even use a shannon#44,into the incision,and run the burr at mid speed,in a side to side stroke until you feel the rough boney surface.this is indicative of removal of all matrix tissue.
you don't need a tourniquet and you need to apply a digital bandage consisting of 3x3 gauze,with 3in kerlix and coban,dressed with neosporin.you follow up in 3 days.at which time the patient is given home care instructions,the same as you would with any matrixectomy.the difference her is that they would be able to return to a normal shoe in one week.you may also give them a digital tube pad to wear initially with their shoes.
this already being practiced quite a bit in britain.it has been taught by stephen isham,d.p.m.,in the states.you may look him up at the website of the academy of ambulatory foot and ankle surgery.i hope this helps

Podrick

Many thanks for your very helpful reply.


Regards


Stephen

__________________
'There are no problems - only opportunities to be creative' :)

Mark,
I've not had a chance to read it yet, but you could have a look at:

Davies C S, (1993) A Clinical Study Comparing Post Operative Healing Times Following Chemical Nail Cautery Using Phenol and Sodium Hydroxide, Journal of British Podiatric Medicine, July 101-103.

Regards,
Lee

Cheers Lee, I'll dig it out.

I have been using NaOH for maybe 20 years now. Found it more easier less drainage and less regrowths than Phenol.

__________________
Michael Z. Metzger, DPM, MBA
PodDirect Office Dispensing
www.poddirect.net

Mark.
This is what i call dr.vazquez triple technic for partial matrixectomies, i do a rasping tehcnic witha burn or nail-bone rasp, use a Phenol 88% twise for 2 minuts and vaporize the matrix remaing with co2 laser this give an average of 96-97% success. is an expensive tool, but is excelent for this procedure. The co2 laser can be use alone with a 91-92% average of success. send me your e-mail and i can send you a complete lecture about this a-to-z. ADIOS dr.vazquez,d.p.m.,m.d.