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Please help

recently a 36 y/o male consulted me in ragards to his right 1st nail, which he had treated by a podiatrist for onychocryptosis 2 yrs previously. the podiatrist (believe it or not) cut a V-shape into the proximal edge of the nail, causing the nail to split straight the middle of the nail. although this cured the O/C, the patient is now left with a permanently split nail, that i presume involes the matrix. the patient often has to file the dorsal surface of the nail as the 2 parts of the nail overlap.

the patient has very broad, fan-shaped nails.
what is the best way to treat this surgically??

1) NWR with phenol matrisectomies to both sides of the nail, which might allow for more "room" for the nail to grow out without overlapping.

2) complete nail avulsion without phenol matrisectomy, which might allow the nail to grow back normally.

any advise would be appreciated.

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Personally I'd do a Bilateral partial avulsion WITH phenol to get the nail to a reasonable size and shape then avulse the remaining part of the nail WITHOUT phenol to try to prevent the split (as part of the same proceedure.)

But I'm a biomechanist, What the hell do i know about nail surgery?

Regards
Robert

I would recommend total avulsion with phenol. I would doubt that if the matrix was affected in the original procedure it is going to recover by further intervention.

hth

s

Hi Ives,

I'm with Simon: TNA with phenolisation.

If considering TNA & only phenolising both sulci & split area of nail does not resolve then further nail surgery may be required.

Perhaps from the patients viewpoint fewer surgical proceedures = less stress long term for patient.

Am just a kind hearted soul.

Regards,

__________________
:)
twirly

Mandy Brooks
Brooks Podiatry
S64 0DE

Suffering a fondness for odd things.

“ Though the mills of God grind slowly;
Yet they grind exceeding small;
Though with patience he stands waiting,
With exactness grinds he all. ”

I'm confused (happens often)

would a TNF with phenol not prevent total nail growth altogether?

personally i'd question the history the patient has given you, i'd be suprised if cutting a V:-

a. did actually cure an oc

and

b. caused the split, some type of trauma to the nail bed more proximally would be my guess

if the problem has persisted for 2 years i'd say that simply removing the nail is unlikely to resolve the problem and the trauma of nail surgery may result in a worsening of the problem or onychogryphosis.

TNA with phenolization for me

cheers
andy

__________________
malpractice makes perfect

cutting the V did not resolve the O/C. the subsequent overlapping of the nail at the split did. and yes i did query the splitting of the nail being due to the cutting of the V, and the patient assures that this was so.

I'm curious, what does TNF stand for, TNA for total nail avusion i've come across, Never TNF. Total nail ...

Tried Not to Freak? Tangerine nail fold? Tacos, No Fahitas?


Robert

Fanx. a LiTtlE fIngEr TrouBle.

TNA to correct myself.

any other advise, or am i in this alone?

The only other thing you aught to consider is: is there anything else which could have caused the nail to split, eg: have you checked for subungual exostosis?

s

Median nail dystrophy.

TNA with phenol if it is problematic, then it won't be a problem any longer.

__________________
Who? What? When? Why? Yeah? And? So? What?

"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

Hi Ives
I would, and have done in the past, perform a total nail avulsion without phenol. `it heals quickly and if there is a chance to save the nail that would be preferable on a patient of that age. If the nail still grows with a split, then total nail avulsion with phenol could be an option

regards
hrm

Hi Simon,

I thought that affected finger nails?

? Alcoholic dystrophic nail change caused by continually rubbibg index finger over thumb nail.

Could be wrong, won't be the 1st time.

Regards,

__________________
:)
twirly

Mandy Brooks
Brooks Podiatry
S64 0DE

Suffering a fondness for odd things.

“ Though the mills of God grind slowly;
Yet they grind exceeding small;
Though with patience he stands waiting,
With exactness grinds he all. ”

For information purposes: rubbibg is a completely new word.

Only to be used by very clever, scientific people

__________________
:)
twirly

Mandy Brooks
Brooks Podiatry
S64 0DE

Suffering a fondness for odd things.

“ Though the mills of God grind slowly;
Yet they grind exceeding small;
Though with patience he stands waiting,
With exactness grinds he all. ”

You see it in toe nails too. I thought the aetiology was uncertain- where do you get the alcoholic rubbibg thing from?

BTW I had some alcoholic rubbibg the other night- very nice; no nail dystrophy yet....

__________________
Who? What? When? Why? Yeah? And? So? What?

"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

Lecture notes from college. (I kept everything),

Dermatology lecture by a Mr. C.D****s {blanked name to protect the innocent}(students were warned about the aforementioned gentle pod, ''making things up on occassion.'')

I thought him wonderful & took all his lecture notes as :the written word.


Simon! Will make u blind, I have heard about 'you' lone rubbibg guys.

There may be a self help group y'know

However, on the other hand I could be completely wrong & thinking of something entirely different.

Regards muchly,

__________________
:)
twirly

Mandy Brooks
Brooks Podiatry
S64 0DE

Suffering a fondness for odd things.

“ Though the mills of God grind slowly;
Yet they grind exceeding small;
Though with patience he stands waiting,
With exactness grinds he all. ”

Hi Ives,

Thought i'd put my 2 cents worth in.
I would look at how problematic the nail really is and what does the patient really want?

I would look at a TNA with phenolisation, that way you will get rid of his problem.

Anyway nail nails are over rated.

Al