AmeriGel® Matrixectomy Pearls

1. Eliminate that "hypersensitive response to phenolization."

Chemical matrixectomies require the use of phenol or sodium hydroxide to cauterize the nail bed. Following cauterization, acetic acid is used to neutralize the sodium hydroxide and alcohol or saline is used to flush the phenol, diluting the chemical's concentration. Residual phenol can remain in the tissues, continuing its caustic activity, until further diluted by serous fluid. This becomes symptomatic for the patient for a few days immediately following the surgical procedure. A bloodless field helps prevent further chemical dilution during the application of either chemical and reduces recurrence rates.

The Material Safety Data Sheet (MSDS) on phenol states that polyethylene glycol (PEG) should be applied immediately to neutralize phenol. The main substrate in AmeriGel® Wound Dressing is polyethylene glycol. Since its introduction into podiatry in 2000, podiatric physicians have dramatically reduced or eliminated the "hypersensitive response to phenolization" with AmeriGel®.

2. Protect the periwound skin from accidental contact with phenol.

Prior to swabbing with phenol, podiatrists typically apply a petrolatum-based preparation to the periwound skin to protect it from accidental contact. This technique repels the phenol off the skin, but does not neutralize it. Instead, apply AmeriGel® Wound Dressing to the periwound skin, which will neutralize the phenol upon contact. AmeriGel® Hydrogel Saturated Gauze Dressing, draped over the surgical site, is ideal to prevent accidental cutaneous burns.

3. The band-aid and post-operative inflammation.

The typical patient is a thrifty shopper and purchases the cheapest band-aids they can find. These band-aids are usually nothing more than a piece of invisible tape with a non-adherent, non-absorbent center, which can be potentially occlusive and cause maceration. If you do not provide quality band-aids to your patients or are unsure about the band-aids your patient will use, provide them with some bulk non-sterile 2x2's. Instruct the patient to cut them in half, and then cut in half again so they end up with a postage stamp size piece of gauze. After they apply AmeriGel®, place the cut piece of gauze over the site, secured in place with the "cheap" band-aid. This will help wick drainage off the site and not be so occlusive. Also, instruct the patient to apply the band-aid loosely around the toe. If applied too snugly, it can inflame and potentially occlude. This happens more frequently on a partial because the plantar fat pad raises and the margins proximate prematurely due to the compression. Instruct the patient to insert a corner of the piece of gauze into the border "slot" so that it acts like a wick. This will keep the site open and allow for adequate drainage, without occluding the surgical site.

4. Inflammation vs. Infection.

Statistically, less than 1% of people are known to have a true contact allergy to oak, the primary ingredient in AmeriGel®. Oak pollen is different because it is airborne and inhaled. A key element in healing a wound quickly is triggering the inflammatory response. Encountering some inflammation with AmeriGel® is common with initial use and should not necessarily be perceived or treated as an infection immediately. It will begin to subside after a few days.

5. Curette, then swab last to minimize the burning or stinging some patients experience.

Curetting the surgical site last may expose a superficial nerve ending and cause a burning or stinging sensation. Swabbing after curettage will prevent this and be much more comfortable for your patient.

AmeriGel®…the new "A" in P&A