Despite being an established procedure, the phenol method remains a controversial one. It is a chemically induced partial matrixectomy with low levels of postoperative pain and infection.

Local anaesthesia is achieved with a digital block and preoperative surgical antisepsis and hemostasis are performed with a tourniquet. A randomized study compared this to partial nail avulsion with trichloroacetic acid (TCA). The results showed similar success rates.

Pre-surgery assessment

Ingrown toenails are a common problem that can be painful and irritating. Although there are many treatment options available, surgery removing the nail edge is often the best option for long-term results. However, it is important to consider the risk factors before undergoing this type of treatment. Infection is one of the most common complications. Infections occurring in the first few days postoperatively are likely to be bacterial and those occurring after a week are most commonly fungal. If a patient experiences a recurrence of ingrown toenails after trying conservative treatments, it may be necessary to undergo further surgery such as chemical matricectomy.

Although the phenol method has low recurrence rates and is less invasive than other surgical techniques, it still has some risks including bleeding, inflammation, and infection. To avoid these complications, it is important to follow a proper pre-surgery assessment and perform the procedure correctly. The first step is numbing the toe with two xylocaine injections and preparing a sterile surgical field. A tourniquet is also used to limit blood flow and increase phenol efficacy. Once the toe is numb, the procedure involves a simple four-step process.

The phenol technique uses an oxidizing agent to destroy the nail matrix, leaving a small amount of keratin to grow through the resulting hole in the nail. The nail is then removed from the toe and the skin surrounding the toe is flushed with a clean solution. The toe is then dressed with antibiotic ointment and bandaged.

While the phenol method has low recurrence rate, it is not recommended for diabetics or those with vascular problems as it can cause severe damage to the skin and limbs. In addition, the phenol treatment can result in permanent loss of the toe nail.

Phenol is a colourless crystal that is extracted from coal and can be found in nature as a natural substance. It is a fungicide, bactericide, and anaesthetic at concentrations over 80%. When applied to the nail, phenol acts as an anaesthetic and coagulates proteins, thereby decreasing bleeding during and after the surgery. A recent clinical trial has compared healing time of patients treated with a 60 s application of 88% phenol to a 30 s application. They found that the 30-s phenol application resulted in a shorter healing time than the 60-s group without compromising effectiveness. This is a significant finding because it can allow patients to return to their daily activities earlier. This can have a positive impact on society as well as the individual patients.

Injections

Various treatment approaches for ingrown toenails have been described including conservative methods such as soaking the foot in warm water with cotton wisps placed under the nail edge and gutter splinting. Surgical treatments such as partial nail avulsion with and without phenolisation, direct surgical excision of the nail matrix and electrocautery have also been used. Despite these different techniques, all have higher incidences of postoperative infection and recurrence than partial nail avulsion with phenolisation (less than 3% recurrence).

Phenol is a colourless crystal substance derived from coal that is bactericidal, fungicidal and a local anaesthetic. It is used in the surgical treatment of severe thick nails and has a wide range of other medical uses. It is contraindicated in patients with severe vascular disease or diabetes.

The phenol method is a safe and effective procedure for treating ingrown toenails but can leave a phenol burn. After the toe is numbed using two xylocaine injections, a tourniquet is applied to restrict blood flow and ensure phenol efficacy. The toe is then soaked in liquid phenol which destroys the nail matrix and is removed after one minute.