Ingrown toenails are a common complaint of patients visiting a podiatrist. This involves the nail plate growing into the surrounding skin, most commonly at either the medial or lateral borders of the nail, with or without a localized infection. They can be very painful, and generally will worsen over time. In the presence of infection, a small abscess may form at the area of the ingrown nail, with a small amount of pus present. The infected skin will become red and swollen, and there will likely be some discharge from the area.
In the podiatrist’s office, these are typically dealt with by excising the offending border of the nail. This consists of making a small cut in the nail longitudinally, and rotating the ingrown border out of the skin. This procedure is done under local anesthesia to minimize the discomfort to the patient during the procedure.
Once the nail border is taken out, a common procedure is the chemical matrixectomy. This involves taking a strong chemical and essentially burning the nail matrix that produces the nail. By burning the matrix, the nail is prevented from growing back in that area, thus preventing recurrence of the ingrown toenail. The chemical matrixectomy has a very high success rate, with a reported recurrence of only 5-7%.
The process most commonly involves the use of phenol, a strong chemical used to burn the nail matrix. Phenol causes proteins to denature, which will not allow the nail to grow back where it is applied. The phenol is usually applied to the nail matrix several times. A piece of gauze may be used to protect the surrounding tissues, so that they are not damaged by the phenol. After the use of phenol, alcohol may be used to dilute the solution. The procedure is commonly referred to as a “P&A”, which stands for phenol and alcohol.
Some clinicians may prefer to use sodium hydroxide to remove the nail matrix, though phenol is much more commonly used. If sodium hydroxide is used, it is followed by an application of acetic acid to neutralize the reaction and stop the damage to the tissues.
Following the chemical matrixectomy, the surgical site is treated like a burn. Silver Sulfadiazine is often used as an antibiotic, and the wound is dressed with a bandage. The procedure will generally heal very well, with minimal time off of work and activity. Generally the doctor performing the procedure will want to follow up with the patient in a week’s time to ensure that the site is healing and there is no infection.
I've had this performed, but only the "phenol" was applied. I've not had any problems with this toenail for over 10 years. Great stuff!
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