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Hey guys, this is Jonathan a.k.a. The Toe Bro here.
I just wanted to say thank you for all the views, all the comments, love the questions, I'm here to help. This time
I'm going to try something a little bit different with this video.
I'm going to do a commentary during the procedure, give you a little bit of background information on
why I'm doing the things I'm doing, and hopefully that can get you guys a little bit curious and a little bit more informed
exactly about this procedure. So before getting into it,
I just want to play the actual clip of me doing the injection of the toe. You can hear us,
how I interact with the patient, and then once that's finished, we can start with the procedure.
So I hope you guys like the videos. Please keep giving me great feedback.
I want to make these videos as best I can for you guys, and informative, educational, and fun for you guys, okay? So enjoy!
Toe Bro: Okay, so I'm just going to wipe down the toe.
Patient: Is it bloody?
TB: No. There's no blood because I put on a little rubber band around it
so there's no no blood, okay? So I'm just gonna wipe down the toes.
TB: You're going to be fine! You're a tough girl! So on the count of three, you're going to be a little pinch and a sting, okay?
P: I'm scared! Can you just wait until I say "Okay"?
TB: Yeah.
P: I'm like really scared right now.
TB: It's such a small thing. It's not that bad.
Other person in room: It's nothing.
P: Okay.
O: You had your nose pierced, come on!
P: So?
TB: So that's what I got double-size alongside Chris brown here, okay? So here we go
little pinch. So on three, you can push your heel into the chair, if you feel pain. One, two, three.
That's the pinch now it stings.
You okay?
P: Yeah.
TB: You're not even flinching!
You okay?
P: Yeah.
TB: See is that bad?
P: No.
TB: You're doing really well. Are you watching?
Any pain?
P: No.
O: No pain?
P: No.
O: There we go.
P: It's going very numb.
TB: Yeah, it is. That's what we want.
No pain right now?
P: No. I'm so scared.
TB: So because it's a little bit infected,
I'm gonna have to add a little bit more than normal because sometimes it takes a little bit more freezing to get a toe like this numb.
You have a small little toe though.
Any pain?
P: No.
TB: So we got to do one more side and the whole toe will be totally numb, okay?
P: Does it hurt on the other side?
TB: Did that one hurt a lot?
P: No.
TB: No, there you go. On three, here we go 1, 2, 3.
P: (?)
TB: 8 days, but I didn't want to tell you, but you're okay.
Any pain over here?
P: No.
TB: See, when you do is every day, you get pretty good. I'm making it easy. Was that bad at all?
P: No.
TB: No. Just pressure right? You feel a lot of pressure?
P: I never even felt the needle in my toe.
TB: One side done.
P: Wow! That looks really swollen!
TB: So that all fluid that we injected into the toe that's what's about I was about to say. So as you can see from her experience,
it wasn't that bad. She made it.
She wasn't in a lot of pain. People think the injection is a lot worse than it actually is. We use a very small, thin needle
and we're very slow and careful and this actually makes the injection a lot less painful. So right now
I'm putting on a tourniquet and why am I putting on this tourniquet?
There's really three main reasons: one, blood loss.
We want to minimize the amount of blood loss during the procedure. Some people are on blood thinners. Some people tend to bleed a lot.
This will stop that. The next thing is we need a bloodless field.
We are going to be applying an acid once
we remove the ingrown toenail to kill the nail matrix. This would stop the nail from ever growing back.
If there's too much blood in the area, it will actually dilute the acid and we might not have
the
reaction that we want. We want it to be very bloodless so that acid does not get diluted, and the last thing is we
want to have a good field of view. The more blood there is in the field, the less
we can see if we removed all of the ingrown toenail, if there is any spike left behind.
After wiping down the toe with the betadine scrub,
I always like to do a second test to the toe to make sure that the toe is completely numb.
I usually do a first test with a toothpick before I even put on the tourniquet, and it's the second test
I do with
the toe slightly covered just to make sure they're completely numb. So what I'm using is a nail elevator to gently
separate the nail from the nail bed. At this point if they're completely numb, there should be no pain at all.
Slight pressure is normal but no pain. So once I know they're completely numb, I will continue to separate the
portion of the nail that's ingrown away from the nail bed and
from the cuticle. We're doing this to reduce the amount of trauma to the remaining nail
and we just want to separate the portion of the nail that we're going to cut back.
By carefully separating the nail from the nail bed,
we minimize the damage to the remaining nail because we don't want to have the remaining nail removed,
we just want to remove the side portion.
After preparing the ingrown portion of the nail and separating it from the nail bed and the cuticle,
I'll be using a special nail cutter to cut to the nail and cut the ingrown portion out. So this is a tricky part.
We don't want to take too much of the nail
or it might not look cosmetically appealing
and we don't want to take too little of the nail because even if we use the acid, we still might get a
recurrence of an ingrown, if the nail is still too wide. So right here
we decide what's the proper portion of the ingrown nail to cut out and we cut all the way down underneath the cuticle.
Now we will be using a hemostat
to clamp onto the ingrown portion and once it's clamped on to the ingrown portion,
we turn it towards the midline of the nail.
This is to properly remove the ingrown, to to minimize the amount of damage to the remaining nail.
This is always a fun part because after turning that hemostat towards the midline of the nail,
we could see how much that ingrown nail was actually stuck in the skin and how much comes out.
Everyone always likes watching this even though they might be a little bit grossed out because since they don't feel a single thing everyone
feels pretty comfortable watching.
So what I'm doing now is I'm using the hemostat to make sure that there's no dead hard skin left behind.
It's very common to see a callous buildup on
the side of the ingrown toenail due to all the pressure from the nail against the skin. So by removing this hardened skin,
we're going to reduce the chance of any discomfort
once the area has healed. So I'm using a cotton tip applicator to dry out the area.
So there's very little to no blood. As you can see, the wound isn't bleeding at all and
after this,
I'm going to use a little tool a curette or Black's file to check
the side of the nail to make sure that cut goes straight, all the way down so that
there's no nail spike left behind or no piece of the nail left behind. This is again to prevent
any sort of regrowth, to make sure the nail was cut properly, and there's no debris left behind, which can actually cause an infection or
stop the healing. So as you can see, the toe is very very clean very
bloodless and this is what we want so that acid doesn't get diluted. If the acid gets diluted, we can actually get a regrowth
of an ingrown toenail and that's what we don't want to happen.
So once I know that there's no ingrown portion left behind, that nail has been cut
properly, there's no debris left behind, and the area is very bloodless,
then I will apply the acid. So what we're using today is an acid called Phenol
and it's a very, very strong acid. What it does is it chemically cauterizes
or kills the any sort of soft tissue cells. So what we're doing is we're applying the cotton tip soaked with the acid
underneath the cuticle where the nail matrix is. We do three to four rounds of
this application of acid and this will actually stop or kill those nail cells from ever growing again
and this is going to prevent any sort of regrowth of nail on the sides.
So after applying the appropriate amount of acid for the appropriate time, I'm using rubbing alcohol, or isopropyl alcohol to
neutralize this acid. This is going to stop any further reaction to the acid.
I'm using more cotton tips to dry out the area clear it out.
Once the reaction has stopped, we'll be dressing the toe with a betadine solution.
This is antibacterial and it helps dry out the wound. A few pieces of gauze and a self-adhesive
wrap.
After the procedure is finished,
I will go through all the instructions on how they're going to take care of the toe verbally. Once they go to the front desk,
we're going to give them a printout of the instructions plus a little kit with all the
dressings, the ointments, the band-aids, the wraps that they'll need to take care of the toe for the first two weeks.
Patients come back after one week for their first follow-up, then usually a month, and then if there's any other issues,
they'll come another month and a half after that.
The patient's toe will be numb for usually 10 to 12 hours because of the long-acting anesthetic that I use.
The first 24 to 48 hours are the toughest for the patient. That's where they're going to feel the most pain and usually it's a
throbbing, pulsating
sensation. After that two day mark, the pain starts to go down gradually and after the first week,
they're back on their feet without any issues.
It's just the first two to three days that are the toughest so wearing an open toe shoe
or a wide shoe to accommodate the wrapping, the bandage, and reduce the amount of pressure on the toe is advised.
But people usually go back to work after two to three days.
So there you guys have it. There's a full video with commentary explaining each step of the way,
understanding why I'm doing the things
I'm doing, giving you guys background information. You guys are definitely going to become pros now and doing ingrown toenail surgery.
I hope you guys enjoyed the video. Hope it was a lot more fun and informative.
The music was a lot more enjoyable for you guys.
Let me know, give me some feedback, some comments, some likes on what you loved and what it could be better
so that way the next video is even better.
Again, I appreciate all the love.
Keep on liking my stuff, keep on giving me the comments and I look forward to
making the next video for you guys. Toe Bro, out.