Nail Surgery Procedure Note

Clinician Specialty: Podiatrist Procedure Partial Nail Avulsion with Phenol Matricectomy Indication Chronic, recurrent ingrown toenail (onychocryptosis) of the left hallux, resistant to conservative treatment and causing significant pain and recurrent infection. Preoperative Assessment Patient is a 32-year-old male with no significant medical history. No known drug allergies. Medications: None. Physical examination revealed hypertrophy of the lateral nail fold of the left great toe, with granulation tissue and purulent discharge. No signs of cellulitis extending beyond the digit. Peripheral pulses palpable, capillary refill time normal. No neurological deficits noted. Anaesthesia Local anaesthesia using 2% Lidocaine with Adrenaline (1:80,000). Batch number: LA20241015A, Expiry date: 2026-03-15. Procedure Details The toe was prepared with antiseptic solution and draped. A digital tourniquet was applied to the base of the left hallux. A Freer elevator was used to gently separate the lateral aspect of the nail plate from the nail bed. A straight nail splitter was then used to make an incision approximately 3mm from the lateral nail edge, extending proximally to the eponychium. The nail segment was grasped with a haemostat and avulsed with a rotational motion. Haemostasis was achieved. A small cotton bud saturated with 88% Phenol was applied to the exposed nail matrix for 60 seconds, repeated three times, ensuring thorough contact with the germinal matrix. The area was then flushed with isopropyl alcohol to neutralise the phenol. The nail sulcus was cleared of any debris. A non-adherent dressing was applied. Pack/lot numbers and expiry dates of materials used: Digital Tourniquet (Lot: DT123, Exp: 2027-01-01), Cotton Buds (Lot: CB456, Exp: 2025-11-01), 88% Phenol (Lot: PH789, Exp: 2026-06-01), Lidocaine (Lot: LA20241015A, Exp: 2026-03-15). Findings Partial nail avulsion successfully performed. Hypertrophic granulation tissue noted beneath the avulsed nail segment. No excessive bleeding during the procedure. Matrix appeared adequately treated with phenol. Complications No immediate complications encountered during the procedure. Postoperative Care Sterile non-adherent dressing applied, followed by gauze and a self-adherent bandage. Patient instructed to keep the foot elevated for the remainder of the day. Dressing change in 24 hours. Keep wound clean and dry. Avoid prolonged standing or activity for 48 hours. Analgesia as required (Paracetamol). Discharge Instructions Patient advised to keep the wound dry for 48 hours. Daily dressing changes with antiseptic solution (e.g., dilute Betadine) and a sterile dressing. Avoid tight-fitting footwear. Report any signs of infection (increased redness, swelling, warmth, pus, fever). Follow-up appointment scheduled for 1 November 2024 to assess wound healing and review. Instructions provided verbally and with a printed leaflet.