Phenol and alcohol chemical matrixectomy.

The phenol and alcohol procedure still remains as one of the most effective and gratifying means of treatment for symptomatic ingrown nails. Most of the literature is concerned with length and manner of application and various forms of postoperative management. Several points must be stressed. In order to be effective, the procedure must be performed in a bloodless field. In lieu of using a tourniquet, a mixture of lidocaine-epinephrine 1:100:000 has been found to be an appropriate way to attain hemostasis. We have not experienced any complication to date. A partial procedure should be performed whenever the remaining nail plate may become symptomatic. Concerning the length and manner of application, the times presented should be used as an average. The application should be based on an observation of tissue change. In general, we have found it more favorable to overapply, rather than risk the chance of recurrence. Preoperatively the patient is fully advised of the projected postoperative period and understands that this will eventually coincide with a more favorable result. Following removal of the offending nail border, we advocate aggressive curettage of the nail groove and matrix cavity. The fresh phenol is applied with pressure within the nail groove, matrix, and roof of the matrix. The use of an alcohol flush serves as a mechanical irrigation rather than a neutralizing agent. The incorporation of Adaptic serves as a drain which is removed on postoperative day 1 along with the accumulated coagulum. This removal of necrotic tissue will facilitate drainage. The patient is instructed to soak in a betadine, salt water solution followed by the application of cortisporin otic solution and dry sterile dressing. The cortisporin otic solution serves as an antimicrobial and anti-inflammatory topical agent. The soaking and cortisporin regimen continue until healing is achieved. Overall, we have found the phenol-alcohol matrixectomy to be simple and gratifying to perform. The procedure is virtually pain free and nondisabling to the patient.