Why use phenol over NaOH for matrixectomies?

[spo01]

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During residency I did all my matrixectomies by physically removing the matrix with a blade because the hospital banned phenol, so I only did chemical matrixectomies a few times at private practices. Now that I'm in my own practice I have been debating which chemical to use. Why don't more practitioners use sodium hydroxide for the matrixectomies over phenol?
I did my research on both and NaOH seems like an easy choice. Yet, I've asked over 30 podiatrists the past year and they all use phenol. They said they've had no problems with it and that's the way they were taught. Is phenol that much better than NaOH?

Benefits of NaOH over phenol:
-Costs significantly less
-Don't have to pay for hazard fees when being shipped.
-Studies have shown patients heal quicker with NaOH and preferred over phenol for diabetics.
-Less time application (3x10 seconds vs 3-4 x 30 seconds)
-Shown to have the same success rate as phenol.
-Easy to neutralize with acetic acid.
-Less inflammation.

It seems like the obvious choice for matrixectomies, what's everyones thoughts?

 

[NatCh]

I use NaOH as do both of my partners.

 

[ldsrmdude]

Welcome back @spo01

I use phenol simply because it's what the practice that I joined has. It's also what I used in residency. I've thought about switching to NaOH for the reasons you mentioned, but haven't really pushed the issue with the powers that be. I haven't had any issues with phenol yet, so it's pretty easy just to keep using it since it's already in our offices. Not a great reason, I fully admit.

 

[NatCh]

It's kind of amazing how much we do because "that's how I was trained." I look back at a lot of the things I was taught and realized there was really a better way to do them.

 

[ldsrmdude]

It's kind of amazing how much we do because "that's how I was trained." I look back at a lot of the things I was taught and realized there was really a better way to do them.

I'm trying my best to keep an open mind as I start practice, but I've used the "it's how I was trained" excuse a few times. I guess it's not always a bad thing (our training has to have a purpose after all and if we disregarded everything we learned in training it wouldn't be worthwhile) but I have seen a lot of doctors do the same thing over and over because it's how they were trained and get the same mediocre or poor results.

 

[dyk343]

I can't stand the smell of phenol. It smells like I am breathing in cancer.

 

[NatCh]

OTOH sometimes wanting to do something differently gets us into weird places. It seems as if our profession as a whole gets easily lured by anything "new and innovative" (e.g., Mini-Tightropes, HemiCAPs, Smart Toes, amniotic fluid/umbilical cord injections, etc.). I heard a story about a sales rep talking to another rep, saying that if you want to find a market for your product "show it to a podiatrist, they'll try anything."

 

[Creflo]

I use phenol because that's what my clinic keeps and I used it in residency. I had one preceptor in podiatry school that used NaOH and had good justification for using it, but I haven't pushed the issue with my powers that be either.

 

[NatCh]

In addition to all of the justifications listed above by spo01, I get less post-procedure inflammation using NaOH than I do with phenol so the patient is more comfortable and the results look less scary to them.

 

[spo01]

In addition to all of the justifications listed above by spo01, I get less post-procedure inflammation using NaOH than I do with phenol so the patient is more comfortable and the results look less scary to them.

Thanks, I added it to the list.

 

[spo01]

Does anyone know the shelf life/expiration of NaOH once the bottle has been opened? Another doctor had given me a bottle of NaOH and it had crystals forming in it so I discarded it and bought a new one. I'm reading mixed things, but this could make a huge difference if one has to replace this often.

 

[NatCh]

Does anyone know the shelf life/expiration of NaOH once the bottle has been opened? Another doctor had given me a bottle of NaOH and it had crystals forming in it so I discarded it and bought a new one. I'm reading mixed things, but this could make a huge difference if one has to replace this often.

I have an unopened bottle from Gordon laboratories with an expiration date of March 2018. According to Gordon laboratories "the date on the bottle is true whether opened or unopened."