Total Matrixectomies

[DPMer]

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Are total matrixectomies (Frost, Winograd, Whitney) typically performed in an operating room, or can they be done in the office setting? Thanks.

 

[347932]

Are total matrixectomies (Frost, Winograd, Whitney) typically performed in an operating room, or can they be done in the office setting? Thanks.

Depends. I don't classically do those in the OR, but have seen some take young children or immuno compromised patients to the OR for those.

Childre are taken for sedation purposes, and immuno compromised are taken for the sterile environment.

 

[NatCh]

Are total matrixectomies (Frost, Winograd, Whitney) typically performed in an operating room, or can they be done in the office setting? Thanks.

I typically do total matricectomy using chemical cautery (sodium hydroxide), but we also have a dedicated procedure room in the office where we can do minor surgical procedures such as a surgical matricectomy if I so desired.

I did have some residency directors (at the VA hospitals) who preferred/required doing the surgical matricectomies in the operating room, however here in the private sector taking a procedure such as this to the operating room would mean changing a $500 procedure into a $5000 (or more) procedure for the patient.

 

[347932]

...however here in the private sector taking a procedure such as this to the operating room would mean changing a $500 procedure into a $5000 (or more) procedure for the patient.

👍

 

[NatCh]

Depends. I don't classically do those in the OR, but have seen some take young children or immuno compromised patients to the OR for those.

Childre are taken for sedation purposes, and immuno compromised are taken for the sterile environment.

I've been able to coordinate doing toenail procedures during dental visits in which the child was sedated by the dentist. He worked on one end while I worked on the other. That way the child only needed one session of anesthesia. Everyone was happy.

 

[347932]

I've been able to coordinate doing toenail procedures during dental visits in which the child was sedated by the dentist. He worked on one end while I worked on the other. That way the child was only needed one session of anesthesia. Everyone was happy.

Wow nice. Never would have thought of that. Thanks.

 

[NatCh]

Wow nice. Never would have thought of that. Thanks.

I couldn't see having all the cards lined up to do it very often though.

 

[DPMer]

Phenol or sodium hydroxide are used for chemical matrixectomy for partial nail avulsion to treat onychocryptosis.

QUESTION: Could you use phenol or sodium hydroxide for chemical matrixectomy in a TOTAL nail avulsion procedure? Is the phenol/sodium hydroxide step the same as in a partial nail avulsion/partial chemical matrixectomy? Thanks.

 

[NatCh]

Phenol or sodium hydroxide are used for chemical matrixectomy for partial nail avulsion to treat onychocryptosis.

QUESTION: Could you use phenol or sodium hydroxide for chemical matrixectomy in a TOTAL nail avulsion procedure? Is the phenol/sodium hydroxide step the same as in a partial nail avulsion/partial chemical matrixectomy? Thanks.

Yes. You just apply the chemical to the entire matrix after you have avulsed the toenail. The duration of the application is the same.

 

[NatCh]

I actually had to look this up, because I've never used the term "matrixectomy." We usually just call it, "Burning that sucker off."

If you all don't mind indulging a Navy GMO: What reason would you have to take an adult to the OR for this procedure? I do quite a few of these under a digital block, have never had a complication that I know of. It seems fairly benign (we use silver nitrate, due to the potential issues of storing phenol). It never would have occurred to me that you would need an OR for it.

GMO = genetically modified organism? J/K. General medical officer.

For a chemical matricectomy I also do not see any reason to take the patient to an operating room.

For a surgical matricectomy (e.g. Frost, Winograd, Zadik, etc.), in which one is using a scalpel to make an incision into deeper tissues that approach bone, people have argued that the sterile environment of an operating room is preferred or required.

Kidsfeet above explained that he would consider taking pediatric patients to the operating room for the sake of sedation and immunocompromised patients for the sake of improved sterile environment, both of which are situations that seem reasonable to me.

 

[Feli]

As was said, surgical matricectomies are typically office procedures in adults. They're pretty low risk and you can save the pt some time and a lot of money.

For kids, or when they're done in conjunction with other more involved procedures, then OR is the way to go.