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Best practice PNA dressings?

Discussion in 'Australia' started by hard_corn, Dec 8, 2013.

  1. hard_corn

    hard_corn Member


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    Dear friends,

    Question please about patient dressings following PNA procedure.

    There seems to be marked non-uniformity between practitioners regarding this, but then again, we all have our own styles and protocols.

    So I am wondering, do you still advocate putting betadine liquid down the surgical site?

    Or is something like solugel a better option?

    Is it necessary to put an anti microbial like betadine on every day for a week following surgery? Or is this over the top?

    Thanks, wishing to apply best practice to my patient.
     
  2. pdoan01

    pdoan01 Active Member

    Hi,

    I believe betadine is cytotoxic to new epithelialising cells and there will prolong post op healing times. If phenol matricectomy is performed you are already doing damage to the site. Would betadine not cause further issues? Could you maybe prescribe or refer off for prohylactic antibiotics if there is an infection risk?

    Cheers.
     
  3. toughspiders

    toughspiders Active Member

    I personally use Jelonet and Kaltostat (if reqd) and melolin x 2 (in that order) to prevent crusty sticking in 2-3 days! and painless removal!
     
  4. phil

    phil Active Member

    I agree with the Buff Arachnid (toughspiders). My preference is jelonet with melolin + coban tape. Review 2-5 days.
    I really make sure they understand how to identify signs of infection and to seek medical help.
    Agree with above comment about povodine iodine being cytotoxic. Not a good thing for repeated use.
     
  5. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    My post operative regime for nail procedures always includes copious amounts of povidone iodine liquid.

    First and foremost, my principal concern with any wound is infection. Povidone iodine is an exceptional anitmicrobial, and affective against bacteria, virus's, yeast and fungi. It is non-selective, and will also be effective against a variety of MRSA strains.

    Regarding the issues of cytotoxicity. Be careful if propagating what I would almost describe as the *myth* of povidone-iodine cytotoxicity.

    There have been as many studies which have demonstrated no effect of cytotoxocity as there have been those that do claim so. There appears to be no actual conclusive evidence that it is particularly harmful to wounds, and at least two studies claim it is beneficial to healing.

    If indeed there is slight negative effect of the rate of wound healing, this is overwhelmingly less important than reducing the chance of infection.

    In a subtropical region like my own, infection is always my greatest fear - not, if actually even a bit true - a couple of extra days healing time.

    Here's a nice review of the evidence here, Iodine Revisited.

    LL
     
  6. toughspiders

    toughspiders Active Member

    Must say i have to agree with Lucky Lis, Iodine has been in and out of favour for years. I have had nothing but good experiences with it over the years, i choose not to use it on nail surgery sites post op but may use Inadine later in the game if the toe if just getting a bit too moist for my liking!
     
  7. Paul Bowles

    Paul Bowles Well-Known Member

    You are quite prepared to pour sodium hydroxide or phenol into a wound but won't use povidone iodine because it "allegedly" may impair wound healing. Anyone see the irony in this?

    Lets get over the dogmatic approach to Podiatry.
     
  8. mburton

    mburton Active Member

    The application of phenol will have disposed of bacteria within the site. I advise patient to shower/bath as normal, getting the dressing wet, and then, once they have dried and dressed themselves, change the wet dressing without touching/cleaning/drying the wound. I provide a supply of simple adhesive 5x7cm dressings such as Mepore and review in 1/12.
     
  9. dyfoot

    dyfoot Active Member

    I use Povidone Iodine to clean the wound after flushing with Saline then pack with Silver Gauze (Acticoat Flex 7), dress with secure breathable dressings then leave on and keep dry for 1 week. No apparent problems with impaired healing or infection thus far........
     
  10. mburton

    mburton Active Member

    [
    [/QUOTE]

    IMHO Dyfoot this is over and beyond for procedures I would undertake in clinic. Once you have removed the offending portion of nail and phenolised the matrix the area shouldn't really need to be bombarded with all these antibacterials and most will resolve without incident with simple dressings and good hygiene.

    Antibiotics can cause your patients MANY more problems than the application of a drop or 2 of Betadine, especially if they are elderly or have complex medical issues. In these days of C. Diff and multiple bacterial restistance to ABs the argument for prophylactic ABs would have to be pretty well supported to justify it.
    :santa:
     
  11. Paul Bowles

    Paul Bowles Well-Known Member

    Is Dyfoot has no apparent issues with clinical infections or wound healing post op then there is nothing wrong with their current regime.

    Wound care is evidenced based and clinically indicated. There is "better" way than anyone else. There are lots of theories, lots of ideas but at the end of the day if you have low post operative infection rates and no major complications with wound healing then obviously what you are doing is working just fine. AT the end of the day it is only a partial nail avulsion - its minor surgery if you can even regard it as that at best and really should be treated as a minor wound in terms of healing and care. Obviously in patients who are at risk or have other medical issues complicating their care (implants, heart valve replacements, warfarin therapy to name but a few) the right precautions should be undertaken to ensure as good a possible outcome as possible. In dealing with experienced Podiatrists over the past 15yrs ive always found that clinically they generally know their patients best when it comes to wound care.

    My one "no no" for minor nail procedures is the use of kaltostat or similar dressings - we did a review a few years back which involved several clinics using this post PNA and they had an extraordinarily high infection rate. Which was the reason why we were asked to review them - they were concerned. A simple change to bactigras as a drain (changed at 24hrs) with a light absorbant dressing such as melolin - and plenty of TLC reduced their infection rate to sub 5% the following year. Which was a dam site better than the 50% or 1:2 they were seeing....
     
  12. Paul Bowles

    Paul Bowles Well-Known Member


    I must have been half asleep typing that this morning!!! Ive corrected above where it should have been....never get on Pod Arena before coffee....
     
  13. hard_corn

    hard_corn Member

    Very good posts, many thanks. This is such a wonderful community to learn and seek advice from others, many thanks. Especially those of us in rural areas without ready access to colleagues, much appreciated.
     
  14. toughspiders

    toughspiders Active Member

    pmsl, or witout the addition of alcohol.....
     
  15. dyfoot

    dyfoot Active Member



    I don't always use Povidone Iodine before the Silver Gauze, but Ilike the Silver because we can leave it on for a week and as I said before, I haven't had any problems with it.

    Also, I can't prescribe antibiotics and you can't rely on patients to have good hygiene!
     
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