Phenolization or Phenol matricectomy

Boll described phenolization in the United States as early as 1945. Phenol matricectomy is a very useful procedure and is used whenever it is necessary to destroy part of or a whole nail. Numerous matricectomy techniques have been described: electrocoagulation, carbon dioxide laser photocoagulation, partial surgical excision of a lateral nail crescent including the nail, nail bed and corresponding matrix, etc.

Phenol matricectomy is a simple technique; it is conducted at the doctor’s practice under local anaesthesia. The sequels of the procedure are straightforward and cause little pain; its results compare favourably with the best techniques (less than 3% recurrences).

Phenol is a colourless crystal derived from coal. It is a bactericide [>1 %], fungicide [>1.3%] and a local anaesthetic. At concentrations over 80%, phenol coagulates proteins. Used on large skin areas (as in chemical peelings of the whole face), phenol is toxic (heart and kidneys).

Phenolization is indicated in the treatment of ingrown nails (juvenile ingrown nail, pincer nail) or to destroy very thick nails where no medical treatment can be used. Severe vascular disorders are the only contra-indication to the use of the technique.

Local anaesthesia is achieved by two xylocain injections in the base of the toe.

The foot is carefully scrubbed with an antiseptic. A sterile surgical field and a tourniquet are needed to ensure phenol efficacy.

The dermatologist removes the narrow strip of nail that penetrates the flesh: a 3mm wide strip is removed on the whole length of the nail. In order to destroy the “root” of the nail, 88% phenol is applied for approximately 60 seconds using a small spatula.

Phenol application Immediately after phenol application

A dressing (antibiotic ointment, dressing gauze and adhesive band) is applied on the toe.

Postoperative pain is limited (pain on pressure or on walking), a standard painkiller is however indicated. Most patients can return to school or work immediately after the procedure.

Limited drainage is usual for two to four weeks after phenolization. Postoperative care is given everyday: antiseptic soaks, application of antibiotic ointment, dressing gauze and adhesive band.

Complications are very uncommon, the risk of infection is low.

Recurrence rates (2 to 3%) are similar to those of other techniques. The occurrence of a “nail fragment” requires a new procedure, easily accepted by the patients.

Patients are generally very pleased with the results, they are satisfied with the procedure (especially when they have previously experienced traditional surgery) due to the absence of pain and to the possibility of going back to work immediately.

Juvenile ingrown nail before phenolization Juvenile ingrown nail after phenolization

1. Abbott W.W.,Geho E.H., Partial matricectomy via galvanic current. J Am Podiatry Assoc 1980; 70 : 239-243.
2. Andrew T.,Wallace W.A., Nail bed ablation: Excise or cauterize? A controlled study. Br Med J 1979; 1 : 1539.
3. Baran R., Dawber R.P.R., Un traitement simple, la phénolisation. In Baran eds. Guide médico-chirurgical des onychopathies, paris: Arnette, 1990,134
4. Boll O.F.,Surgical correction of ingrowing nails. 1945; 35 : 8-9.
5. Bouchie R.T., Matricectomy utilizing negative galvanic current. Clin Podiatr med Surg 1986; 3 : 449-456.
6. Brown F.C., Chemocautery for ingrown toenails. J. Dermatol. Surg. Oncol 1981; 7 : 331.
7. Dagnall J. C. The development of nail treatment. Brit J. Chirop 1976; 41 : 165.
8. Fosnaugh R.P. Surgery of the nail. In Epstein E., Epstein E. Jr, edts. Skin Surgery vol II. Springfield, Illinois: Charles. C. Thomas, 1982, 987-992-1000-1002
9. Fulp M. New enzyme aids phenol technique in nail surgery. J. Podiatry. Ass 1972 ; 63 : 395.
10. Gibbs R.C. Treatment of uncomplicated ingrown toe-nail. J. Dermatol. Surg. Oncol 1978; 4 : 438.
11. Gilles G.A., Dennis K.J., al et. Periostitis associated with phenol matricectomy. J Am Podiatry Assoc 1986; 76 : 469-472.
12. Greig J.D., Anderson J.H., Ireland A.J.,Anderson J.R. The surgical treatment of ingrowing toenails. J Bone Joint Surg. 1991, 73 B, 131-133.
13. Haneke E. Surgical treatment of ingrowing toenails: Cutis, Apr 1986, 251-256.
14. Johnson D.B., Ceilley R.I. A revised technique for for ablation of the matrix of nail. J. Dermatol. Surg. Oncol 1979; 5: 642.
15. Kaplan I., Landthaller C. B., Labandter H. Onychogryphosis treated with the CO2 surgical laser. Brit. J. Plast. Surg 1976; 29: 102.
16. Leshin B., Whitaker D. Carbon dioxide laser matricectomy. J Dermatol Surg Oncol 1988; 14: 608-611.
17. Mann R.A. Surgery of the foot. Saint-Louis : C. V Mosby Co, 1978.
18. Mc Glamry E.D. Management of painfull toes from distorded toenails. J. Dermatol Surg Oncol 1979; 5: 554-556.
19. Monheit G. Matricectomy. In Daniel R., eds. The nail, Dermatologic Clinics, Vol 3, Philadelphia: W.B Saunders Compagny, 1985,526-529.
20. Murray W.R., Bedi D.S. The surgical management of ingrowing toenails. Brit. J. Surg 1975; 62: 409-412.
21. Nyman S.P., The phenol alcohol technique for toe nail excision. J NJ Chirop Soc 1956; 5 : 4-6.
22. Rinaldi R., Sabia M.,Gross J. The treatment and prevention of infection in phenol alcohol matricectomies. J. Am. Podiatry. Ass 1982; 72: 453.
23. Ross W. R. Treatment of the ingrown toe nail and a new anesthetic method. 1969; 49: 1499-1504.
24. Salashe S.J. Surgery. In : Scher R., Daniel R.I., eds. Nails: Therapy, Diagnosis, Surgery, Philadelphia : W. B. Saunders Compagny, 1990, 276-278.
25. Siegle R.J., Harkness J., Swanson N.A. Phenol alcohol technique for permanent matricectomy. Arch Dermatol 1984; 120: 348-350.
26. Suppan R.J., Ritchlin J.D., A non debilitating procedure for ingrown toe nail. J Am Podiatry Ass 1962; 52 : 900-902.
27. Travers GR.., Ammon R.G., The sodium hydroxyde chemical matricectomy procedure. J Am Podiatry Assoc 1980; 70: 476-478.
28. Van der Ham A.C., Hackeng C.A.H., YO Ti. The treatment of ingrowing toenails : A randomized comparison of wedge excision and phenol cauterization. J Bone Joint Surg. 1990, 72B, 507-509.
29. Wee G. C., Tucker G.L., Phenolic cauterizations of the matrix in the surgical cure of ingrown nails. Minn. Med 1969; 66: 802.
30. Zaias N., Matrix destruction. In : Zaias N., eds. The nail in health and disease, Norwalk, Connecticut: Appleton & Lange, 1990, 74.