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  #1  
Old 03-24-2011, 04:45 PM
jharvey963 jharvey963 is online now
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Anyone ever had a "surgical matrixectomy"? (Surgical removal of a deformed toenail)

My podiatrist recommended that I have a surgical matrixectomy: this is a surgical permanent removal of a damaged and deformed toenail.

While this sounds minor, my doctor says I'll be bandaged for 14 days, with very limited use during this time. Also, I should keep the foot elevated.

Have you ever undergone this procedure, or know someone who has? I'm looking for:

* What the surgery itself was like for you.
* What happened after the surgery?
* How much pain were you in?
* How long did the bandage stay on?
* Were you able to walk at all after the surgery?
* How long did it take to heal?
* How long before you felt you were completely healed from it?

The usual "you are not a doctor" caveats apply. I'm just looking for other's experience with this procedure.

Thanks,
J.
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  #2  
Old 03-24-2011, 05:36 PM
Qadgop the Mercotan Qadgop the Mercotan is online now
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Quote:
Originally Posted by jharvey963 View Post
The usual "you are not a doctor" caveats apply. I'm just looking for other's experience with this procedure.

Thanks,
J.
Well, I am a doctor who has done this surgery. Does that disqualify me from replying?

It's a pretty easy, mindless procedure: I did one this morning, without the nail ablation (just yanked it cuz it was ingrown, it'll grow back) in under 10 minutes. I can do them in my sleep, I often have.

Most patients walk easily after it's done. The toe is numb so it's not a problem. The first night it may throb a bit, but ibuprofen or acetaminophen is usually able to abate the pain enough. Within a few days, they're 90% back to normal, and in about 2 weeks, it's all over and done. Even my worst drug-seeking patients didn't request anything stronger (of course they knew they wouldn't get it).

The day after the surgery, I have the patient see the nurse, who changes the dressing, and issues bandaids to the patient, who then takes care of the toe after that, changing them as needed a few times a day. Within 3-6 days no bandage is usually necessary. Keep it clean, wash with soap and water, a dab of antibiotic ointment, and there you have it.

Last edited by Qadgop the Mercotan; 03-24-2011 at 05:38 PM..
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  #3  
Old 03-24-2011, 05:52 PM
JCorre JCorre is offline
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When I was in grade school I had to have this done a couple times. This would be over 25 years ago so I'm sure the procedure has changed.

I had to have half of my right big toenail removed because it was so badly ingrown.

I'm sorry to tell you that the pain of getting the local anesthetic administered was intense. Normally my pain tolerance is quite high but I was producing involuntary tears during that part.

After that it was a snap. Couldn't feel anything in the toe for hours and after that the pain was almost non-existent. This was probably augmented by the fact that the previous pain from the ingrown toenail was also gone.

Walked on it the whole time. Bandages for a week and then I was fine....until it happened again the same year.
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  #4  
Old 03-24-2011, 05:54 PM
jharvey963 jharvey963 is online now
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Quote:
Originally Posted by Qadgop the Mercotan View Post
Well, I am a doctor who has done this surgery. Does that disqualify me from replying?

It's a pretty easy, mindless procedure: I did one this morning, without the nail ablation (just yanked it cuz it was ingrown, it'll grow back) in under 10 minutes.
My operation apparently includes the ablation. We don't want the nail to grow back. It was damaged when I was a kid and has never been right since then. (He also said they do something with the skin -- maybe stretch it? -- and stitch it together.) The procedure is done under "light anesthesia", and the doctor said the bandage doesn't get changed for 14 days. So this seems to be a bigger deal than the one you're talking about. Have you ever done this type?

Thanks,
J.
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  #5  
Old 03-24-2011, 05:58 PM
jharvey963 jharvey963 is online now
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Quote:
Originally Posted by JCorre View Post
When I was in grade school I had to have this done a couple times. This would be over 25 years ago so I'm sure the procedure has changed.

I had to have half of my right big toenail removed because it was so badly ingrown.
Thanks for replying, but this is still a less severe procedure than they're going to do to me.

They are going to completely remove the nail and destroy all of the roots so it never grows back.

J.
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  #6  
Old 03-24-2011, 06:10 PM
Qadgop the Mercotan Qadgop the Mercotan is online now
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Quote:
Originally Posted by jharvey963 View Post
My operation apparently includes the ablation. We don't want the nail to grow back. It was damaged when I was a kid and has never been right since then. (He also said they do something with the skin -- maybe stretch it? -- and stitch it together.) The procedure is done under "light anesthesia", and the doctor said the bandage doesn't get changed for 14 days. So this seems to be a bigger deal than the one you're talking about. Have you ever done this type?

Thanks,
J.
I generally ablate the nail by removing the nail then painting the nail bed with phenol, and getting it up into the matrix. In my experience, this prevents the nail from growing back in better than 90% of the cases, and really doesn't make the post-op period very different from what I described earlier. I've done it for badly ingrown nails which recur repeatedly, and also for badly deformed nails.
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  #7  
Old 03-24-2011, 06:39 PM
Jonathan Chance Jonathan Chance is offline
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Hello. My name is Jonathan Chance and I am missing both of my big toe nails from this procedure. A few years ago both of my nails went...wacky. My pod said it was a fungal infection that only went after big toe nails (what do I know?).

Both got taken about 2 months apart. Very little fuss and muss. A little blood and some treatment and bandages. It still feels weird sometimes and the nail bed is effectively numb to the touch. But there was little pain. A small amount of local and some of that 'freezing' stuff the ballplayers use and it was done.

It is, to me, a 'no worry' procedure.

Hmm. I see you're telling people 'sounds like mine is more severe' so I'll describe the procedure as I remember it.

1. Wrap the base of the toe. Force all the blood out into the foot and wrap it so tight that the blood doesn't come back in.
2. Some sort of painkiller injected into the base of the toe.
3. Freeze the toe with a spray.
4. Insert a small, flattish knife under the nail. I watched and it seems like it should hurt but it didn't.
5. Wiggle knife back and forth to separate the nail from the nailbed. WARNING: this goes way back UNDER the top of the toe. Severely weird.
6. Pull nail off. Seemed E-Z.
7. Use some form of acid to burn the nailbed and kill whatever it is that makes the nail grow. Do that quite a bit.
8. Clean, wrap, and tape.
9. Check in 10 days for issues.

Note, I walked home from both procedures and, while it was gingery I didn't really have a problem.

How'd I do, Qadgop? Close?

Last edited by Jonathan Chance; 03-24-2011 at 06:44 PM..
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  #8  
Old 03-24-2011, 06:46 PM
aceplace57 aceplace57 is offline
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Had this done twice in high school in the doctors office. No big deal. Shot in the foot to numb. Took a few seconds to pop off the big toenail. I Had to wear a slipper with the top cut out for a couple weeks.

in grown nails are a nuisance

Last edited by aceplace57; 03-24-2011 at 06:47 PM..
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  #9  
Old 03-24-2011, 06:52 PM
Ranchoth Ranchoth is offline
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I've had this done (assuming I'm talking about the same procedure, or something close to it)—both big toes. They kept getting ingrown (painfully), so I finally got the sides of the nails cut out and chemically cauterized (or whatever the proper term is).

Real easy procedure—just went in as an outpatient thing. Once at the hospital, the other at a sports medicine clinic. The latter, they had be scrub off my foot with Betadyne the morning of the procedure before I went in.

The anesthetic injection probably hurt the worst (per usual), and the nail bed burned a bit after it wore off, but nothing crippling. Both cases, I walked (well, limped) out of the office under my own power. Tried to keep off my feet for a day or two, IIRC.

Less trouble than dealing with a broken finger, and healed up pretty fast. The cauterization mostly worked, except for one side of one nail, where a little sliver of nail still grows back (albeit much reduced from how it was before), which I just easily clip back. The nails don't even look freaky or noticably narrow...almost disappointing. I might have been able to make up some good gory story about it.
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  #10  
Old 03-24-2011, 08:02 PM
j666 j666 is offline
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Quote:
Originally Posted by jharvey963 View Post
Have you ever undergone this procedure, or know someone who has?
Yes, someone I know opted to have the nail removed rather than even try the drug that requires monitoring liver function for possible liver damage.

* What the surgery itself was like?

Took very little time; done under local anesthetic; didn't need a minder and drove home alone.

* What happened after the surgery?
* How much pain were you in?

Rather a lot, but 800 mg motrin kept it under control.

* How long did the bandage stay on?

Replace nightly

* Were you able to walk at all after the surgery?

Drove home, walked around fine, but had to buy shoes a half size larger

* How long did it take to heal?
* How long before you felt you were completely healed from it?

It's still sensitive after two months.

YMMV and all that.
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  #11  
Old 03-24-2011, 08:47 PM
astro astro is offline
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It looks like I'm the only one who really did not like the way my toenail removal procedure turned out.

When I was 18 both my big toenails would regularly get ingrown spurs that I had to keep cutting out. Sometimes they would get infected and there would be a tiny bit of pus. Went to see a podiatrist and he decided to tackle the left nail. He sliced out the sides so I had this weird long skinny toenail. It wasn't great looking but it wasn't awful so I lived with it.

Around 30 years old I dropped a real estate sign on that left toe. This was the sort of hit where a normal toenail would turn black and drop off and regrow. I did not realize the doc had effectively destroyed my nail "bed" with the slice out surgery. The long skinny nail tuned black and what regrew was this gnarled little nail the size of a shirt button that forms this thick little mound of nail where the nail material is kind of buckled up on itself instead of being a nice symmetric sheet. I grind it down to little white button of uniform thickness with a Dremel moto tool sanding disk every 6 months to keep it from getting too big and thick. I refuse to wear open toed sandals.

After my 20th birthday my right big toenail never bother me again re ingrown spurs. I'm pretty sure if I had left the left one alone the problem would have gone away by itself.
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  #12  
Old 03-24-2011, 10:55 PM
ShelliBean ShelliBean is offline
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astro - you sound just like my SO. He has the same problem - the mound of misshapen keratin that has to be dremeled down every once in a while. I have seen him without socks only maybe 5 times in 3 years, and that is just before or just after a shower. I think it is a serious source of embarrassment. His is also the result of a (somewhat minor) crush injury.

Is the benefit for the surgery strictly cosmetic for you? I have very slightly encouraged him to have it removed but he claims his doc said that it would just grow back the same way. I can't imagine he discussed the difference between ablating the nail bed or not. I almost feel certain the doctor's pronouncement that surgery would do no good is actually an offhand comment made on the way out the door in 1985 and my SO has clung to it.
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  #13  
Old 03-25-2011, 01:00 AM
surrounded by literalists surrounded by literalists is offline
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I haven't done the procedure like the good doctor, but I have assisted with many of them. The doc I work for numbs the toe by injecting 4 sites around the base of the toe.

* If you are squeemish you don't want to watch the next part*

A long flat blade is used to seperate the nail from the toe. After the nail is removed, he treats the nail 'matrix' with a strong chemical that kills the cells that generate nail material.
Next he rinses the chemical off with saline, applies and antibiotic cream and wraps the toe with gauze and coban.

After 6 hours and twice a day for the next week, the patient needs to soak the toe in clean warm water for 20 minutes. After soaking, apply neosporin and a bandaid. Have the doctor check in a week. Soak once a day for the second week.

Thats all there is too it.

Soaking twice a day is key to keeping the toe free from infection. It also makes if feel better.

We would do this procedure on prison guards who would go straight back to work afterwards. Most people really get in a twist worring about the pain, but they find that the procedure is way less painful than the ingrown nail.

The only reason for concern is if you have a secondary issue that would compromise circulation in your toes: such as venous insufficiency, diabetes, peripheral edema and the like.

Last edited by surrounded by literalists; 03-25-2011 at 01:01 AM..
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  #14  
Old 03-25-2011, 01:49 AM
TravisFromOR TravisFromOR is offline
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I've had it done three times. Same toe.

It's no biggie. I was back to normal in two days. (I couldn't get my shoe back in the afternoon after the morning I had it done last time.)

Next time it gets ingrown, I am having them kill the nail. I'm getting sick of shelling out a couple of hundred dollars every few years for that stupid toe.

Last edited by TravisFromOR; 03-25-2011 at 01:50 AM..
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  #15  
Old 03-25-2011, 03:26 AM
astro astro is offline
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Quote:
Originally Posted by ShelliBean View Post
astro - you sound just like my SO. He has the same problem - the mound of misshapen keratin that has to be dremeled down every once in a while. I have seen him without socks only maybe 5 times in 3 years, and that is just before or just after a shower. I think it is a serious source of embarrassment. His is also the result of a (somewhat minor) crush injury.

Is the benefit for the surgery strictly cosmetic for you? I have very slightly encouraged him to have it removed but he claims his doc said that it would just grow back the same way. I can't imagine he discussed the difference between ablating the nail bed or not. I almost feel certain the doctor's pronouncement that surgery would do no good is actually an offhand comment made on the way out the door in 1985 and my SO has clung to it.
I called a podiatrist's sometime after the injury and the described my problem to the nurse answering the phone. She told me point blank there was no hope for regrowing the nail normally as the nail bed was compromised. While the nail button will get nasty if I let it go, when trimmed down to a flat(ish) nub it's pretty inoffensive. It just looks odd.

Unless there is someway of destroying the nail at the growth site it will continue to grow. Honestly I'd rather have the button than nothing, even though it's odd looking it does provide some minimal protection to the top of the toe. Going bare with just flesh on the top of the toe given all the hits a foot takes over time doesn't seem like a good idea.
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Old 03-25-2011, 11:48 AM
drastic_quench drastic_quench is offline
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I had both big toe nails removed in middle school. I raced in four events in a track meet the next day. My white track shoes soaked through with blood, but it really didn't hurt much at all. I got a crazy amount of respect and reputation out of it.
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  #17  
Old 03-25-2011, 12:14 PM
surrounded by literalists surrounded by literalists is offline
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Quote:
Originally Posted by astro View Post
I called a podiatrist's sometime after the injury and the described my problem to the nurse answering the phone. She told me point blank there was no hope for regrowing the nail normally as the nail bed was compromised. While the nail button will get nasty if I let it go, when trimmed down to a flat(ish) nub it's pretty inoffensive. It just looks odd.

Unless there is someway of destroying the nail at the growth site it will continue to grow. Honestly I'd rather have the button than nothing, even though it's odd looking it does provide some minimal protection to the top of the toe. Going bare with just flesh on the top of the toe given all the hits a foot takes over time doesn't seem like a good idea.
We had a lady who had several toenails removed. She went to the store and got those Lee Press On Nails and put them on her toes. She would wear sandals and every thing and you couldn't really tell unless you looked closely.
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