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Hi

I saw a patient last Friday who has had her right hallux nail removed by a surgeon. I can't remember the name of the procedure, but they cut down by the proximal nail fold, both medially and laterally. The problem is, where the nail bed (I'm assuming) has been removed, hypergran is present and lots of it, no infection. I'm used to seeing hypergran when the toe has become infected and had lots of trauma, but not afterwards. We always used silver nitrate in that case, but this lady's vascular system is not so great, so a baulked at using it. Any ideas would be greatly appreciated, I just popped a dry dressing on for protection on Friday.

Many Thanks

+Hi in these circumstances I use Curasalt if there is no infection. If infection suspected then Acticoat or Iodaflex. Hope you have similar products.

Sounds like a zedics section. Nasty op, we've not done them for years. Personally i'd go ahead with the silver nitrate. If its hypergranulating the circulation can't be all that bad!

I would use the AgNO3 aswell, but if you are still concerned about the vascular system then i commonly use Mesalt, the 30% sodium chloride will draw out the moisture form the area via the osmatic nature of the hypertonic environment created and will promote epith very fast. The only problem will be that it sometimes causes pain when applied, but this is usually described as a 'drawing' or 'sucking' pain, and is usually not bad enough and its more discomfort then pain.

But personally, silver nitrate it, the hypergran. tissue wouldn't be there if there wasn't blood.

Rgds, Torin

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Torin O'Grady
Podiatrist
Singapore General Hospital
Singapore

I agree with all above, but if there is lots of H.gran you can sharp debride it the use the AgNO3 to control the bleeding

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Stephen Tucker
Eastern Health
Podiatry Manager

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