Phenolization or Phenol matricectomy

Author : Dr Philippe Abimelec
Last scientific update : November 2016

YOURS QUESTIONS ABOUT PHENOLIZATION

Abstract

Boll described phenolization in the United States as early as 1945. Phenol matricectomy is a very useful procedure and is used whenever it is necessary to destroy part of or a whole nail. Numerous matricectomy techniques have been described: electrocoagulation, carbon dioxide laser photocoagulation, partial surgical excision of a lateral nail crescent including the nail, nail bed and corresponding matrix, etc.

Phenol matricectomy is a simple technique; it is conducted at the doctor’s practice under local anaesthesia. The sequels of the procedure are straightforward and cause little pain; its results compare favourably with the best techniques (less than 3% recurrences).

Phenol is a colourless crystal derived from coal. It is a bactericide [>1 %], fungicide [>1.3%] and a local anaesthetic. At concentrations over 80%, phenol coagulates proteins. Used on large skin areas (as in chemical peelings of the whole face), phenol is toxic (heart and kidneys).

Phenolization is indicated in the treatment of ingrown nails (juvenile ingrown nail, pincer nail) or to destroy very thick nails where no medical treatment can be used. Severe vascular disorders are the only contra-indication to the use of the technique.

Technique

Local anaesthesia is achieved by two xylocain injections in the base of the toe.

The foot is carefully scrubbed with an antiseptic. A sterile surgical field and a tourniquet are needed to ensure phenol efficacy.

The dermatologist removes the narrow strip of nail that penetrates the flesh: a 3mm wide strip is removed on the whole length of the nail. In order to destroy the “root” of the nail, 88% phenol is applied for approximately 60 seconds using a small spatula.

Application de phénolisation
post-phénolisation
Phenol application
Immediately after phenol application
s

A dressing (antibiotic ointment, dressing gauze and adhesive band) is applied on the toe.

Postoperative pain is limited (pain on pressure or on walking), a standard painkiller is however indicated. Most patients can return to school or work immediately after the procedure.

Limited drainage is usual for two to four weeks after phenolization. Postoperative care is given everyday: antiseptic soaks, application of antibiotic ointment, dressing gauze and adhesive band.

Complications are very uncommon, the risk of infection is low.

Recurrence rates (2 to 3%) are similar to those of other techniques. The occurrence of a “nail fragment” requires a new procedure, easily accepted by the patients.

Patients are generally very pleased with the results, they are satisfied with the procedure (especially when they have previously experienced traditional surgery) due to the absence of pain and to the possibility of going back to work immediately.

ongle incarné
phenol
Juvenile ingrown nail before phenolization
Juvenile ingrown nail after phenolization

Bibliography

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