Comparative efficacy of 10% sodium hydroxide, 88% phenol, and 90% trichloroacetic acid as chemical cauterants for partial matricectomy in the management of great toe nail onychocryptosis

Context: Lateral plate avulsion with chemical matricectomy is the treatment of choice for ingrown toenails. Phenol is the most widely used cauterant, followed by 10% NaOH and more recently trichloroacetic acid. Aims: To evaluate the efficacy of 10% NaOH, 88% Phenol, and 90% TCA in cauterizing the matrix with regular follow up post surgery and clinical photographs. Materials and Methods: Fifteen adult patients presenting with ingrowing toe nails were recruited to the study with prior consent. The NaOH group (Group A) had five patients and five nails treated, the phenol group (Group B) had five patients and six nails treated, and the TCA group (Group C) had five patients and six nails treated. A total of 17 great toe nails were treated. Following proximal digital block and partial nail avulsion, the matrix was curetted and the lateral horn cauterized with 10% NaOH (1 min), 88% phenol (3 min), and 90% TCA (3 min). Post-procedure follow-up was done at weekly intervals to evaluate post-operative pain, oozing, and wound healing. Statistical Analysis Used: Graph pad prism software was used for statistical analysis. ANOVA tests were used to test the statistical significance between post-operative parameters of each group. Results: Mean duration of post-op pain in Group A was 4.2 days; Group B was 8.6 days, and Group C was 1.2 days. Oozing occurred for a mean duration of 10.6 days in Group A, 14 days in Group B, and 5.6 days in Group C. Mean duration of tissue re-epithelization was 28.4 days in Group A, 40.5 days in Group B, and 27.4 days in Group C. Conclusions: TCA is an effective cauterant for chemical matricectomy with the advantage of less duration of post-op pain and faster healing.