Ingrowing Toe Nails & Infection: What Do You Do?
Colleagues:
Prior to the management of IGTN with infection, is it common practice to treat the infection with antibiotics before addressing the nail with a procedure?
I have observed, and have heard this advice in local US clinics/hospitals, issued to a patient, that an infection with an IGTN must be treated first.
This is contrary to what I practiced in England. In raising this topic, I have in mind a 'typical' healthy patient without co-morbidity. A good majority of those cases will be treated definitively with ablation followed by phenolisation. The cause of the infection, more often than not, the impacted nail spicule in the periungual soft tissue. The solution is to remove the offending nail fragment. Or, remove the affected soft tissue. Either way, to separate one from the other.
Phenol is, probably, the most potent topical antiseptic available. The rationale: any bacteria encountered during the procedure is definitively treated at the time of phenol application. If there are concerns, this is followed with antibiotics to treat any infection after the procedure. Or occasionally load the patient with antibiotics for a couple of days just prior to the procedure.
This regime is/was taught and applied routinely, and in every clinic I have attended over the years.
So, my question, is there additional value to the patient in delaying definitive treatment?
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