Nail question

[Creflo]

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So I did a partial matrixectomy and about 3 months later the patient has a horizontal partial tear (not a Beau line or Mee line) in the nail plate, beginning on the side of the matrixectomy and extending about 2mm, about midway distally down the nail, is growing out. I'm hoping this will grow out, but have never felt totally confident about management of such nail defects. Does anyone have any advice? I read that biotin 2.5mg QD for 6 months can help onychoschizia, maybe would help here too. Anytime we had nail plate separation in residency we just cut off the loose part and I never really understood what else to do for cases like the above mentioned and onycholysis, etc. Always felt I was kind of leaving the patient hanging by just saying "keep it trimmed." Thanks for any advice.

 

[ExperiencedDPM]

So I did a partial matrixectomy and about 3 months later the patient has a horizontal partial tear (not a Beau line or Mee line) in the nail plate, beginning on the side of the matrixectomy and extending about 2mm, about midway distally down the nail, is growing out. I'm hoping this will grow out, but have never felt totally confident about management of such nail defects. Does anyone have any advice? I read that biotin 2.5mg QD for 6 months can help onychoschizia, maybe would help here too. Anytime we had nail plate separation in residency we just cut off the loose part and I never really understood what else to do for cases like the above mentioned and onycholysis, etc. Always felt I was kind of leaving the patient hanging by just saying "keep it trimmed." Thanks for any advice.

If this was a chemical procedure using phenol, it's not unusual. Unlike "cold steel" you don't have complete control of where the phenol "goes" and if it damages some of the nail or matrix medial or lateral to the border you avulsed, the changes may be permanent. Although we take precautions when using the phenol, it's still a liquid so there is only so much control we have.

I always discuss with patients pre procedure, that abnormal growth to the remaining nail or damage is possible to the remaining nail. I also tell patients that some clear yellowish drainage is normal since a chemical burn has been created. This decreases the amount of calls you'll get regarding patients thinking the area is infected. There is a difference between pus and normal drainage and/or erythema following a chemical burn. In my experience erythema occurs much more frequently in fair skinned patients.

And if you aren't, please use a consent form for ANY procedure. This is a surgical procedure so a consent is needed to protect yourself.

 

[NatCh]

I'm not sure I'm picturing the defect correctly. It's a small split in the nail extending transversely from one border towards the centerline of the nail? Is the patient complaining that the nail gets hung up on socks or something like that?

 

[Creflo]

That describes it exactly, the patient is ok with it, it's not getting caught on socks.

 

[NatCh]

I see that on occasion. It'll grow out. If it bothers the patient there are some nail repair products available from retail health and beauty merchants that are supposedly effective, but I've never used them myself.

Example:
https://www.amazon.com/gp/aw/d/B002KYF068/ref=cm_cr_arp_mb_bdcrb_top?ie=UTF8