CORN ENUCLEATION SURGERY
A corn or clavus is an area of well circumscribed hyperkeratosis of the skin with a dry, smooth and slightly convex surface caused by intermittent direct pressure exerted on a small area. Its size varies from 1 mm to 2 cm and it is conical in shape. It is composed of a cone shaped wedge of compressed hyperkeratotic stratum corneum with the base of the cone towards the surface of the skin and the apex pointing inwards. It presses upon the adjacent tissues and causes severe pain when pressed due to pressure on the nerves. Corns are mainly classified as soft corns occurring between the toes and hard corns occurring on the exposed plantar surface or dorsolateral surface of the small toe.
Plantar corns are recalcitrant to the medical line of treatment and being very painful need surgical intervention.
After Preoperative preparation the hyperkeratotic tissue surrounding and over the corn area is paired with no. 20-24 sterile surgical blade till erythema or transition from hard to less hard tissue occurs. The central core or kernel of the corn is visible more clearly after the above procedure.
A disposable biopsy punch, which encircles the central core, according to the size is taken and with a very slow and gradual rotatory half circular motion is pushed into the tissue. Before applying the punch on patient's skin, the patient is explained that at the point when he or she feels pain sensation or an increase in the pain sensation, he or she should immediately inform to surgeon. This would be firmly explained to the patient because this is the end point of the procedure and the surgeon should withdraw the punch without further extension into the tissue. If the punch is pushed deep into the tissue it may lead to severe pain, deep tissue injury and deep wound which may heal with a delay.
The punched out tissue is held with Adson's toothed forceps and is gradually pulled without cutting. This leads to the complete extraction of the tissue with the central intact core excised. It is the cauterized with Electrocautery(Conmed Hyfrecator). The pressure bandage is applied over the wound and the patient is instructed to use soft foot wear. The dressing is changed after 5 days.
Patient is advised to wear Soft protective footwear for long term.