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Post Surgery Redness - Ingrown Toenail

Discussion in 'Ask your questions here' started by mlb, Feb 1, 2009.

  1. mlb

    mlb New Member


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    My son had surgery for one ingrown toenail on Wednesday, 4 days ago. The doctor numbed the toe, then sliced down to the cuticle and removed a strip of nail. It was swollen and a little pus came out during the surgery. He has been on cephalexin 500 mg 3 times a day, and has been soaking the toe 2 times a day in epsom salt and warm water. Today, Saturday, I noticed that his whole foot is redder than the other non-surgery foot. I have a call into the dr. but they haven't called back. Should we go to emergency or wait? Thank you
     
  2. mlb

    mlb New Member

    I don't know how to edit my first message. In addition, the dr. used phenol (SP?) to kill the nail bed. My son is using a triple antibiotic ointment after soaking in Epsom salt water, then covering with gauze and wrapping a rubbery tape around the toe to keep the gauze on.

    The surgery was done immediately because my son couldn't walk to his college classes, and I couldn't get a podiatrist in his school town. So, I brought him home and had this done so that he can get back in school. I hope I've provided the right amount of detail. Thank you!!
     
  3. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
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    I generally consider it inappropriate to do the type of procedure which, by your post, I infer was done on your son, or any nail surgery other than drainage of the infection when there is an existing infection present as seems to be the case as you mentioned the release of pus. My strong preference is to resolve the infection first, and then do the corrective nail procedure when the infection is cleared. That is because performing elective surgery in the presence of an infected area can potentially drive the infection deeper and cause its extension proximally. That being said, sitting at my computer, I cannot determine whether the redness is due to an exacerbation of the infection or to a severe reaction to the phenol, a situation which is not uncommon. I would certainly think that he should be seen at once by a doctor who can make that differentiation and determination and can treat accordingly, though I will predict that most ER doctors will see it as an infection unless they have had previous experience at making the differentiation. When in doubt, treating it as an infection is generally the most prudent avenue. I see no justification, though, why a doctor who does surgery is either not available to his/her patient or has not arranged promptly available alternate coverage that is.
     
    Last edited: Feb 1, 2009
  4. mlb

    mlb New Member

    Thank you for your reply. I agree with you about the doctor not calling back for 3 hours. I got your response and also asked an acquaintance who's a hospitalist. Based on both of your responses, we went to emergency ASAP, as it could have been an antibiotic resistant bacteria. The emergency room said that Keflex is no longer a viable antibiotic. They put him on a different antibiotic. I also followed my friend's advise which is good advise for any worrisome infection: 1) we had the infection cultured to determine if the antibiotic picked will work or even worse... 2) we used a sharpie to draw a line showing the boarder of the redness so that we can tell if it gets worse or better. If it gets worse,, the antibiotic isn't working.

    The doctor on call finally called back when we were leaving for the emergency room. I chose not to listen to her, and to go to emergency.

    Thank you for your advise. I wish I had gone to this website before the surgery!
     
  5. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
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    Be advised that once a systemic antibiotic has been employed, even if it is not the best choice, subsequent culture and sensitivities may be unreliable, as the initial antibiotic may have already modified the flora and may even have killed off the major pathogen. On the other hand, unless it were MRSA, without a culture and sensitivity, Keflex (cephalosprorin), in my opinion, was not an inappropriate choice. In addition, I did point out to you that most ER doctors would reflexively see this as an infection instead of any consideration of its instead being a phenol reaction which is the more common cause of such symptoms after a phenol nail surgery, though, when in doubt, it is certainly appropriate to treat it as an infection. But other than the fact that your podiatrist did perform the surgery in a possibly infected area, I would not necessarily get too down on her, as these symptoms may have had nothing to do with an infection.
     
  6. Unregistered

    Unregistered Guest

    Thank you again! We are going to see her for a follow-up today, and she's my GP, so I really appreciate your message.
     
  7. J in Pain

    J in Pain Guest

    I had my toenails done 2 weeks ago and now have a severe infection. I went to the ER and have been back to the doc a few times. he thinks it is an allergy to phenol (at first he thought the amerigel, but that doesnt make too much sense). I have drainage and am in lots of pain. He had to drain the toe once because it doubled in size, but it is still infected and I am off the oral antibiotic but am still using the gentomicin. Do you think something else could be going on with my toes (both sides of both toes were done, and all 4 are infected). Also, how long will this take to heal? I'm about to go on week 3 now, and it is no better. I can hardly walk, have been wearing flip-flops every day. I have pictures of my toes from the beginning until now that I am more than willing to share.
     
  8. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    You say that you have and infection and then you say its a sensitivity to phenol, so which is it? Either can occur with destructive toenail surgery, and although some aspects of the treatments of each might be similar, they are not necessarily identical. Although "allergy" would likely not be the correct term to employ, EVERYONE is sensitive to a tissue destruction chemical such as phenol. The problem in discerning whether it is an infection or a sensitivity reaction may not be easy, as the symptoms are often quite similar. Although it may prove inaccurate as you have had an antibiotic, attempting to culture the drainage or doing a gram stain of the exudate may be the only method of definitively determining which it is, although certainly both problems can co-exist. Irrespective of which it is, normally treatment would include the institution and maintenance of drainage. Certainly, if it is an infection and if the infection appears to me extending proximally or if there are symptoms of septicemia, rapid and appropriate action which would likely include targeted antibiosis may be critical. If you are not confident with the decisions or treatment of your doctor, as seems to be evidenced by your posting a question here, seek a second opinion from a well-qualified alternate. There is no one who has not examined you and made a definitive diagnosis who can accurately and responsibly predict the length of course or its outcome. Although it might not clear much up, you certainly can post your pictures right on this website or post the address of any website where you might prefer to post them.
     
  9. j in pain

    j in pain New Member

    The 2 pictures attached were taken last night. It has now been 2 weeks since the surgery.
     

    Attached Files:

  10. j in pain

    j in pain New Member

    These two pictures were taken last week (so you can see the difference).
     

    Attached Files:

  11. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    As I had suggested, not a whole lot can get cleared up by viewing photos as to whether you are suffering an infection or a phenol reaction or both. But what I am seeing is not a terribly uncommon though undesirable occurrence following a phenol toenail procedure. I would have to assume that any good podiatrist has seen this many times and should be able to handle it adequately. I would think that the prospects of completely normal and corrected nail plates resulting is probably not too great. Make certain that your doctor keeps on top of this and report to him/her any exacerbation or extension of the area of redness. The time for complete resolution of your case will likely be longer than you would like.
     
  12. JJ In Pain

    JJ In Pain Guest

    I would think that the prospects of completely normal and corrected nail plates resulting is probably not too great.

    What do you mean by this?
     
  13. FootDoc

    FootDoc New Member

    Phenol destruction of the nail matrix of the ingrowing segment of the nail is the most common podiatric procedure for dealing with ingrown toenails on a hopefully permanent basis. But it is often difficult to cause the phenol to destroy ONLY the matrix tissue of the formerly offending nail segment without having at least some effect on the adjacent matrix tissue which is intended to be preserved. Both infections and severe phenol reactions often cause some effect to the remain nail matrix tissue which can range from complete destruction of the tissue intended to survive the procedure, with then total and permanent loss of the entire toenail, or, more often, varying degrees of less than fatal effects on the remaining nail matrix resulting in damaged nail matrix and subsequent permanently deformed nail growth.
     
    Last edited: Feb 27, 2009
  14. j in pain

    j in pain New Member

    It has now been 1 month + 3 days and after seeing another doctor for a second opinion, the infection is still very much present. The new doctor wants to numb up my toe and start digging around but Im not sure that is a good idea. I am on no antibiotics, just soaking my toes and putting on Neosporin. Why was a bacteria culture never done? Is that something that is not normal? Isn't having infected toes for over a month not normal?
     
  15. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS-ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    I think that I have covered essential the same information with you in the past, and if you re-read my responses, most if not all of your present questions will likely have been addressed. I come here to offer general information only. Posters are not to expect that I can or will act as a consultant for individual patients and cases. The questions that you are asking here should be address to your own doctor, and if he/she cannot answer them to your satisfaction, then perhaps you have chosen the wrong doctor for you.
     
  16. danny1123

    danny1123 New Member

    sir i had ingrown toenail surgery yesterday i was wondering if when it drains if that is normal honestly it is kinda scary
     
  17. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS-ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    If you have an ingrown nail and it has begun to drain, my best guess is that you have an infected ingrown nail and the abscess has opened. I would advise that you seek immediate medical attention so that an appropriate course of action might be taken. Assuming that there is, in fact an infection, warm, but not hot soaks and a sterile gauze pad dressing would generally be appropriate until you can head for the doctor which, as I have said, should be without delay.
     
  18. Unregistered

    Unregistered Guest

    Hello Doc, this is fial from the philippines. I have this ingrown for almost 3 years now, within the range of years, i had undergone nail-removal surgery for 3x already, since I have no idea of the POST-OP CARE and my doctor is a general surgeon and podiatrist here are very rare my ingrown is aggravating again by the time my nail is growing back. 1st, total nail was remove, the 2nd was half, and the last time, just the other day was also half-nail remove. Specifically, it is my right big toe, only the left corner. My concern is why this is coming back, hope this will be the last time my nail will be remove, since it affect my activities of daily living. Thanks and more power.
     
  19. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS-ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    The actual removal of the nail plate does not keep it from coming back. The nail matrix, which resides proximal to the base of the nail must be destroyed or removed. Surgical removal of the nail matrix is generally a more reliable procedure, but chemical destruction is more easily performed, though there is no way of determining during the surgery if the required portion of the matrix has been completely destroyed and often more than is desired is destroyed or affected. Recurrences, especially when chemical destruction is attempted are not at all uncommon. Most general surgeons are not sufficiently experienced with toenail surgery and their rates of success are likely less than would be for an experience podiatrist. But podiatrists also have failures with the procedure.
     
  20. Unregistered

    Unregistered Guest

    Are you based in the Philippines?
    I would like to have some few consultations coz i have the same prob regarding my toenail and i dont know where to go...
    im having a hard time putting my feet into a shoe especially closed as it starts to pain when i walk...
     
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