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Sunday, September 27, 2015

Chronic Ingrown Toenail: Email Correspondance Post Chemical Nail Root Procedure

One of my patients recently came in for a chronically ingrown toenail. He wanted a permanent fix, so I suggested he schedule for a chemical matrixectomy (where 2 applications of 89% phenol is used to kill the root (aka matrix) cells. 5 days before this email the procedure was performed, and I had emailed the patient to see how he was progressing. 

Patient's Response:

Thanks for the follow-up email, Dr. Blake.  I was just going to email you today!

My toe is doing great.  Outside of a little on the first day/night, I have had zero pain.  I also have had zero oozing, and virtually no bleeding.  In fact, the only blood I see is on the tip of the Q-Tip when I insert it at the base of the nail halfway thru the soakings.  And actually that little has even stopped, as I ran out of the Q-Tips you supplied, and now I am using regular store bought Q-Tips.  It seems to me that I could even stop the soakings, as I don’t see them adding anything?
Dr Blake's comment: I tell the patients to soak twice daily for one hour for 2 days, then twice daily for 30 minutes until they feel like the soreness is diminishing and healing going well, then once a day for 30 minutes for a minimum of 4 weeks (and it can be up to 6 weeks). The acid, which has been used to destroy the nail forming cells, produces dead tissue which the body needs to flush out. Keeping the wound open for the first couple weeks with Qtips or face cloth, prevents the hole from sealing over, and allows the bad stuff to come out. 

In fact, my ONLY concern is if the wound has “closed up” or “scabbed up” (mentioned sometimes happens), and so the needed discharge is not happening.  Does that seem possible/probable given the info above plus the two pictures?
Dr Blake's comment: You photo below looks like the wound is really open well. Good job with the Qtip!!

Let me know if I should continue with the soakings, the Q-Tip “gentle jabbing” (with slight pain), and/or the antibiotic with band-aid – and if so, for how much longer?

Thank you again!

Typically after all this soaking and covering, the wound needs to be less macerated with 50% air exposure. As soon as you are home for good, soak for the 30 minutes, then dry off and leave open to the air all night until the next morning. Oxygen (air) is a great healer.

Dr Blake's comment: 

     You are definitely looking good. Continue once a day 30 minute soaking to continue to pull  out. You do not need the q tip, but each day after you bath, take a face cloth or piece of gauze and gently scrub the wound placing pressure on the nail border and then wiping outwards away from the nail for 30 seconds. Makes sense?? Send me more pictures in 2 weeks. During the day, topical antibiotic and bandaid. During the evening 12 hours, expose to air. Great healing!!! Rich

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.