Haemostasis in Wart Curettage

I have been speaking to a few podiatrists lately about their experiences with wart curettage and I have noted that getting adequate haemostasis (bloodless field) during the procedure is proving difficult. I noted these problems myself when I first began doing these procedures and gradually worked out what needed to be done to achieve a bloodless field. I have outlined the procedure below:

I have also shown the approach I take to doing tibial nerve blocks (which is a common approach by many). The patient is layed prone and I have just recently begun using liquid nitrogen prior to the injection to reduce needle pain (another common trick). Aim for the posterior aspect of the medial malleolus approximately 1-2 cms above the distal aspect of the malleolus. Obviously you do not always have to do a tibial nerve block for wart curettage and indeed I generally lean towards local infiltration to expedite the process of anaesthesia.



The first stage in exanguanating the limb is putting a towel around the leg. This is to reduce the pain of a highly inflated cuff and distributes pressure from the cuff more evenly. The pneumatic cuff is then placed over the towel (mid-calf) but not inflated.



Next a crepe bandage is wrapped around the foot to "milk the blood" from the area.



With the crepe bandage still in place the pneumatic cuff is inflated (I usually just inflate to the maximum pressure of 300 mm/hg) and then the crepe bandage is removed. The cuff will feel tight but this is much better than all the other options you have.

The foot with the crepe bandage removed should then appear white and if you look at SVPFT it should be very slow or non-existent.



I hope that helps a few people.

Matt