What are the post-procedure care instructions for a patient who underwent a permanent partial lateral extraction for an ingrowing great toenail on the left big toe using lidocaine 1% (local anesthetic)?

Post-Procedure Care Instructions for Permanent Partial Lateral Extraction of Ingrown Toenail

After a permanent partial lateral extraction of an ingrown toenail with phenol application, patients should keep the toe bandaged for 24-48 hours, then clean the site daily with mild soap and water, apply antibiotic ointment, and rebandage until drainage stops (typically 1-2 weeks). This approach minimizes infection risk and promotes optimal healing.

Immediate Post-Procedure Care (First 48 Hours)

• Keep the original dressing intact and dry for 24-48 hours to allow initial healing and prevent contamination
• Elevate the foot above heart level when sitting or lying down to reduce swelling and pain
• Take prescribed pain medication or over-the-counter analgesics (acetaminophen or NSAIDs if not contraindicated) as needed for pain control
• Limit weight-bearing activities for the first 24-48 hours to minimize pain and bleeding

Wound Care After Initial 48 Hours

Daily Cleaning Protocol

1. Gently remove the bandage once daily
2. Clean the wound with mild soap and warm water
3. Dry thoroughly by patting gently with a clean towel
4. Apply antibiotic ointment to the wound site
5. Rebandage with a clean, dry dressing

Important Considerations

• Continue this daily wound care until drainage stops (typically 7-14 days) 1
• Expect some drainage which is normal following phenol application
• The duration of drainage is typically shorter (approximately 11 days) when phenol is used during the procedure 2

Activity Guidelines

• Resume normal activities gradually over the first week
• Wear open-toed shoes or sandals for the first week to avoid pressure on the toe
• Avoid strenuous activities involving the feet for 1-2 weeks
• Swimming and bathing should be avoided until drainage stops to prevent infection

Follow-Up Care

• Schedule a follow-up appointment in 1-2 weeks to assess healing
• Contact your healthcare provider immediately if you experience:
  • Increasing pain, redness, swelling, or warmth
  • Purulent discharge or foul odor
  • Fever or chills
  • Bleeding that doesn't stop with gentle pressure

Long-Term Nail Care

• Trim toenails straight across and not too short to prevent recurrence
• Wear properly fitting shoes with adequate toe box space
• Keep feet clean and dry to prevent infection
• Avoid cutting into the corners of the toenail

Common Pitfalls and How to Avoid Them

1. Premature removal of initial dressing: This can introduce bacteria and disrupt early healing. Keep the original dressing intact for at least 24 hours.

2. Inadequate wound cleaning: Proper daily cleaning is essential to prevent infection. Use mild soap and water, not harsh antiseptics that can damage healing tissue.

3. Excessive activity too soon: This can cause bleeding and delayed healing. Gradually increase activity as tolerated.

4. Improper nail trimming after healing: Cutting nails too short or rounding the corners increases recurrence risk. Always trim straight across.

5. Ignoring signs of infection: Early intervention for infection is crucial. Know the warning signs and seek prompt medical attention if they occur.

The evidence strongly supports daily wound care with cleaning and application of antibiotic ointment until drainage stops 1, 3. Following these instructions will minimize complications and promote optimal healing after permanent partial lateral nail extraction.