TFP Thread

[air bud]

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Shouldnt AI tell you what's going on.

 

[Hybrocure]

Yeah this is basic nail stuff but do you guys ever have to work up PAD for ingrown nails? These are super annoying. 75 year old, controlled diabetic, nonpalp pulses x rays shows calcified vessels even digital ones. Fibrotic slough to the nail border and a small eschar and the toe looks red with the purpleish hue.

Feels like you can’t just do a temporary nail avulsion without going through all these vascular workup steps.. I actually did one once because I justified it by saying “well it’s infected” and because the patient refused vascular studies and it turned to a mess.

is there anything to do in the meantime for these patients besides oral abx/mupirocin or betadine while you’re waiting for vasc studies and a possible vasc referral..

Any like gimmicky soaks/cotton balls or whatever?

I don’t mess with these at all. I had a patient referred to me who got an outside matrix w PAD that ended in a BKA.

Debride the nail. Put them on abx til revasc.

 

[Hybrocure]

I haven't touched a Doppler in 5 plus years. I use my brain not ears to diagnose vascular disease.

For real. Just look at the patient

 

[Adam Smasher]

I got my doppler off ebay, was about $700

Remember, toenails are just skin appendages, so simple avulsions (no matrixectomy) are going to be safe. Or at least it's a risk/benefits estimation. I've done avulsions liberally in pad pts and have been lucky...so far

I've made this comparison before: to say that a toenail procedure caused an amputation is like saying the assassination of Francis Ferdinand caused WWI. Yes it catalyzed things, but all the stuff happening in the decades prior led up to it and it was bound to happen no matter what.

 

[SoleSucking]

I got my doppler off ebay, was about $700

Remember, toenails are just skin appendages, so simple avulsions (no matrixectomy) are going to be safe. Or at least it's a risk/benefits estimation. I've done avulsions liberally in pad pts and have been lucky...so far

I've made this comparison before: to say that a toenail procedure caused an amputation is like saying the assassination of Francis Ferdinand caused WWI. Yes it catalyzed things, but all the stuff happening in the decades prior led up to it and it was bound to happen no matter what.

I think you meet the wrong patient it’s going to get you. I just happened to have mine early in my career that I learned my lesson on. I too thought a simple avulsion can’t cause much harm, and as uncle @Feli mentioned I think even the injection did harm as he got a wound by that.

 

[air bud]

I think you meet the wrong patient it’s going to get you. I just happened to have mine early in my career that I learned my lesson on. I too thought a simple avulsion can’t cause much harm, and as uncle @Feli mentioned I think even the injection did harm as he got a wound by that.

Was this patient neuropathic? Did you even need to numb them up? Doing a simple avulsion on neuropathy it's fine to just rip that baby off, no local needed.

 

[SoleSucking]

Was this patient neuropathic? Did you even need to numb them up? Doing a simple avulsion on neuropathy it's fine to just rip that baby off, no local needed.

Maybe could have looking back but didn’t even consider at the time that even an injection could do that much damage. If I can’t feel pulses I really think from now on it’s slant back/abx/betadine until I have studies.

That’s what the few articles on this essentially recommend full vascular workup too. So I would say that’s standard of care.

I don’t have enough vascular docs in my area to just send them every pad patient so I’m trying to filter them before I hit the “vascular” button like the lizard meme.

.

 

[air bud]

Maybe could have looking back but didn’t even consider at the time that even an injection could do that much damage. If I can’t feel pulses I really think from now on it’s slant back/abx/betadine until I have studies.

That’s what the few articles on this essentially recommend full vascular workup too. So I would say that’s standard of care.

I don’t have enough vascular docs in my area to just send them every pad patient so I’m trying to filter them before I hit the “vascular” button like the lizard meme.

View attachment 408852.

Feeling pulses is overrated. You would never do any ingrowns then....i maintain use your brain. This is an ingrown nail. How can you kill a tow with the physical act of removing a nail. First of all, if ever a concern it's a total not a partial. Can generally do a total much less a traumatically than a partial. Anyway....takes time and experience. Obviously this approach works until it doesn't.