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Post-op care following surgical removal of plantar warts. Advice please.

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  #1  
Old 10th August 2009, 04:39 PM
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Default Post-op care following surgical removal of plantar warts. Advice please.

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Hi to all those Podiatrists who sometimes (maybe always) surgically remove plantar warts,


I was interested in knowing what the standard care is following this procedure. Once the Pt's wart has been removed and it is in the healing stage, a lot of the time callus and dry blood/necrotic tissue form over the post-op site (in most Pt's the dry blood/necrotic tissue fills the wound site) even 5 weeks post-op.

Is it better to leave the site alone and allow it to heal and get rid of the necrotic tissue on its own?

Or is it prudent to debride the site and clear it of necrotic tissue/callus to aid with the healing process?

Cheers to all in advance,


FD

Last edited by Foot Doc : 10th August 2009 at 04:40 PM. Reason: Addition of info
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Old 11th August 2009, 01:20 AM
DAVOhorn DAVOhorn is offline
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Default Re: Post-op care following surgical removal of plantar warts. Advice please.

Why would you Surgically Remove Verucca Pedis Lesions?????

It is a viral infection presenting as the Verruccous Lesions.

So you excise the lesions and upon healing you are left with scar tisuue which has a habit of being PERMANENT and can be as debilitating as the original Verruccous Lesions.

I do not understand this , i have several patients who have had their Verruccae surgically removed, by Surgeons and Dermatologists, and are not enjoying limping upon the recurring scar tissue.

So what was your reason for surgical excision?

regards David
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Old 11th August 2009, 02:08 AM
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Default Re: Post-op care following surgical removal of plantar warts. Advice please.

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Originally Posted by DAVOhorn View Post
Why would you Surgically Remove Verucca Pedis Lesions?????

It is a viral infection presenting as the Verruccous Lesions.

So you excise the lesions and upon healing you are left with scar tisuue which has a habit of being PERMANENT and can be as debilitating as the original Verruccous Lesions.

I do not understand this , i have several patients who have had their Verruccae surgically removed, by Surgeons and Dermatologists, and are not enjoying limping upon the recurring scar tissue.

So what was your reason for surgical excision?

regards David

Hi David,

Firstly, that wasn't my question. And secondly, where in my post did i say i had surgically removed a VP?

You've completely assumed everything. And just for the record, i don't have a reason for surgical excision...........................because i didn't surgically excise anything. The question was regarding the POST-OP care of such surgery! Because i was interested.

FD
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Old 11th August 2009, 07:09 AM
W J Liggins W J Liggins is offline
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Default Re: Post-op care following surgical removal of plantar warts. Advice please.

Hello

I frequently carry out excholiation of VPs. By the time they reach me the lesions are recalcitrant and the patients will have been through many other forms of t/t including chemical cautery and cryo. Excholiation (ideally) does not penetrate the common integument and therefore does not cause scarring.

To go back to the o/p, my (anecdotal) audit shows a 77% success rate after 12 weeks. I suspect that the failures are due to remaining infected tissue. I would suggest therefore that you just dress the site leaving the coagulum in situ and allow the phages to do their work.

All the best

Bill Liggins
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Old 11th August 2009, 08:24 AM
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Default Re: Post-op care following surgical removal of plantar warts. Advice please.

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Originally Posted by Foot Doc View Post
Firstly, that wasn't my question. And secondly, where in my post did i say i had surgically removed a VP?
Sam:

Here is the title of the thread you started "Post-op care following surgical removal of plantar warts. Advice please."

Next here is a quote from your original message: "Hi to all those Podiatrists who sometimes (maybe always) surgically remove plantar warts.."

What David said was quite valid. Twice in your first post you mention surgical removal of plantar warts and now you say that wasn't your question??? Is this some form of trick question you are giving us in that we are supposed to guess that even though you twice mention surgical removal of warts in your original question we should then assume you don't mean surgical removal of warts when you want an answer??
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Old 11th August 2009, 08:57 AM
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Default Re: Post-op care following surgical removal of plantar warts. Advice please.

OK - lets take a breath!

DAVOhorn:
As you know Verrucae do not extend into the dermis thus these can be easily removed without a scar. If someone ends up with a scar then they excised too deeply.
Excision and /or currettage has been a gold standard for recalcitrant lesions for many many years.

Now we have Needling!

Footdoc:
As far as post op care, we have the patient remove the bandage the day after surgery, begin an astringent soak bid and cover (band aid or dressing depending on size and number)
I usually will not see the patient back unless the lesions are large or large and multiple.

AGAIN: needling is the way to go.


Steve
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Old 11th August 2009, 04:25 PM
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Default Re: Post-op care following surgical removal of plantar warts. Advice please.

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Originally Posted by Kevin Kirby View Post
Sam:

Here is the title of the thread you started "Post-op care following surgical removal of plantar warts. Advice please."

Next here is a quote from your original message: "Hi to all those Podiatrists who sometimes (maybe always) surgically remove plantar warts.."

What David said was quite valid. Twice in your first post you mention surgical removal of plantar warts and now you say that wasn't your question??? Is this some form of trick question you are giving us in that we are supposed to guess that even though you twice mention surgical removal of warts in your original question we should then assume you don't mean surgical removal of warts when you want an answer??
It seems that assumptins are the order of the day. Here's an idea.........how about just answering the questions asked and leave assumption out of it? If you go back to the original post, Kevin, you will find not one question relating to the surgical removal of warts.................they all pertain to Post-op care.
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Old 11th August 2009, 04:30 PM
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Default Re: Post-op care following surgical removal of plantar warts. Advice please.

To bill and Dr. Sarbs,

Thank you very much for the useful and helpful advice. Much appreciated.

Cheers,


Sam
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Old 11th August 2009, 05:33 PM
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Default Re: Post-op care following surgical removal of plantar warts. Advice please.

Quote:
Originally Posted by Foot Doc View Post
Hi to all those Podiatrists who sometimes (maybe always) surgically remove plantar warts,


I was interested in knowing what the standard care is following this procedure. Once the Pt's wart has been removed and it is in the healing stage, a lot of the time callus and dry blood/necrotic tissue form over the post-op site (in most Pt's the dry blood/necrotic tissue fills the wound site) even 5 weeks post-op.

Is it better to leave the site alone and allow it to heal and get rid of the necrotic tissue on its own?

Or is it prudent to debride the site and clear it of necrotic tissue/callus to aid with the healing process?

Cheers to all in advance,


FD
Sam:

Assuming when you say surgical removal of plantar wart, you mean currettement?? For the patients that I do a plantar wart currettement procedure on, I put a xeroform dressing on the foot for 48 hours then, after 48 hours, have them start soaking their foot twice daily, in addition to cleaning the wound with soap and water followed up with a bandaid. They generally wear a bandaid on the foot for about 2 weeks.

However, I tend to prefer the needling procedure over currettement currently since there is less post-op discomfort and self care by the patient. Hope this helps.

By the way, now in rereading your original message, I see what you were talking about. Sorry about being so snippy......
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Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

E-mail: kevinakirby@comcast.net
Website: www.KirbyPodiatry.com

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Sacramento, CA 95825 USA
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Old 11th August 2009, 07:01 PM
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Default Re: Post-op care following surgical removal of plantar warts. Advice please.

Quote:
Originally Posted by Kevin Kirby View Post
Sam:

Assuming when you say surgical removal of plantar wart, you mean currettement?? For the patients that I do a plantar wart currettement procedure on, I put a xeroform dressing on the foot for 48 hours then, after 48 hours, have them start soaking their foot twice daily, in addition to cleaning the wound with soap and water followed up with a bandaid. They generally wear a bandaid on the foot for about 2 weeks.

However, I tend to prefer the needling procedure over currettement currently since there is less post-op discomfort and self care by the patient. Hope this helps.

By the way, now in rereading your original message, I see what you were talking about. Sorry about being so snippy......
Hi Kevin,

Thank you very much for your advice. I personally did not perform the currette procedure, another Podiatrist did. And your advice in this post and others is invaluable as always, so i am very grateful to get it. Once again, thank you

Based upon everything i've heard about needling, i agree with you. Although i haven't used it myself yet, i am looking forward to giving it a go.

And there is no need to be sorry. Im sorry for confusing you and others

Cheers again,

Sam
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Old 13th August 2009, 02:04 AM
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Default Re: Post-op care following surgical removal of plantar warts. Advice please.

The thing I find useful with the needling is that you leave the epidermis in situ and you are not leaving an open wound - much more comfortable easy post op management and less risk of infection!!! COOL!!
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Old 3rd July 2010, 09:24 PM
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Default Re: Post-op care following surgical removal of plantar warts. Advice please.

Hi
I am currently treating a 7 year old patient for a minor VP, but seems to be causing much pain/discomfort when child is mobilising.Ongoing for 6 months now. Palliative care: reduction of overlying callus until minor haem is not proving effective. Child is my brothers kid - so no pressure, but growing impatient in trying to get rid of problem.

Any old scool pods/chirops got any advice
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