The Matricectomy - A
Photographic Journey
Many thanks to the brave gentleman who took all these pictures so I could
show them so clearly on the web site. He showed uncharacteristic bravery for a
guy.
The first photo (1) shows the evil ingrown nail
before we started. He has chronic and recurrent ingrown nails on the left side
of the toe (fibular border). This toe killed him in shoes. He wanted desperately
to get this toe better. Others tried and others failed. Now it was my turn. The
photo on the right shows the first step. I am injecting the base of the toe with
plain Xylocaine after first spraying the injection site with enough Ethyl
Chloride (the bottle behind the foot) to pre-freeze the skin. As I describe
under gentle injections, I used the smallest syringe and the smallest needle
made for this injection. I find these little needles and syringes produce the
least amount of pain. I follow the Xylocaine injection with a second
injection of long acting Marcaine. I do not start with the Marcaine because it
stings so much going into the tissues that I want the toe first made numb with
the gentle Xylocaine. Also note that I inject at the base of the toe where
the skin is loose and movable. Injecting it at the tip of the toe where it is
ingrown (a favorite trick of some urgent care centers) is cruel and unusual
punishment. For more of my injection technique please see -->
1
2
After securing anesthesia of the toe it is scrubbed with a brown
anti-bacterial solution called Betadine. Next I place a blue
"toe-niquet" over the toe to keep any 'red stuff" out of the
wound site. Not only do I not like the sight of the red stuff but it interferes
with the effectiveness of the acid I use to kill the nail root. Next I use a
tiny tool called a curette to loosen the skin away from the edge of the edge of
the toe nail.
4
5
After freeing the edge of the nail plate I use an fancy nail cutter called an
English Nail Splitter to cut the edge of the nail parallel to the side of the
toe (6).
6
After
cutting the side of the nail plate I use a little tweezer like instrument called
a mosquito hemostat to reach in and grab the piece of nail that was inside the
toe. Done correctly you do not have to remove any nail that you can see - just
the nail that is inside the toe itself.
7
Double
click on picture number (8) to see in a large version just how much nail can be
removed without changing the shape of the toe nail itself.
8
After
the edge of the nail plate is removed it is time to kill the edge of the nail
root that causes the edge to grow (9). I use an applicator stick (medical speak
for a Q-Tip) that was dipped in an acid called phenol. To kill the nail root
requires two or three applications of phenol placed directly on the nail root
tissue.
9
10
Finally the toe-niquet is removed and the toe is dressed with an antibiotic
cream, sterile gauze and covered with a compressive bandage called Coban (here
it is blue).
11
After the surgery patients are given the following instructions.
Matricectomy Post-Operative Instructions:
1. It is best to return home and elevate the foot/feet
until the feeling returns (which can take from 2 to 6 hours). At that time
remove the stretchy (usually brown) Coban covering the gauze. Delay taking a
shower or bath for 12 hours from the time of surgery.
2. Clean the nail border(s) using any one of the three
interchangeable methods (not all 3 at the same time):
A) Using a shower of clean tap water - holding the toe(s) under the
shower using it like a shower-pic.
B) Clean the edge of the nail plate with a Q-Tip and hydrogen peroxide
C) Soaking in an (Epsom or kitchen) salt solution and cleaning the wound
edge with a Q-Tip
3. Tomorrow morning do the first cleaning of the toe(s).
Remove the white dressing and clean the wound(s) using one of the three methods
that are interchangeable. After cleaning the nail border(s) please dress the
wound with the prescription antibacterial and cover the toe with a Band-Aid.
Wear regular shoes that are not too tight on the toes.
4. Keep the wound clean including avoiding getting dirt or
sand into he wound and showering only with a Band-Aid or other covering on the
toe(s) until healing is complete. Wounds do not heal faster if they are allowed
to "dry-out" or "air-out"
5. Call the office if the toe becomes more swollen,
painful or red than you think is normal.
6.
Please schedule a follow-up visit for 3 to 5 days after the procedure.
