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
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