What is the post-operative care for a patient who underwent partial removal of the left big toenail's medial aspect?

Post-Operative Care After Partial Medial Toenail Removal

Keep the post-operative bandage in place for one week without daily footbaths, as this approach results in significantly lower infection rates compared to daily soaking regimens. 1

Immediate Post-Operative Management

Wound Care

• Leave the initial surgical bandage undisturbed for 7 days - this simple approach demonstrated significantly lower signs of infection at one week compared to daily footbath protocols 1
• After the first week, apply simple gauze dressing changes as needed 1
• Daily footbaths (whether with alkaline or acidic soap) showed no advantage over simple bandaging and were associated with higher infection rates in the first week 1

Pain Management

• Expect pain to decrease progressively over the first two weeks 1
• Women typically report more pain and slower functional recovery than men 1
• By two weeks post-operatively, pain should be minimal regardless of wound care approach 1

Activity Restrictions

Return to Normal Activities

• Patients typically return to normal daily activities within 10-12 days (range 10-16 days) 2, 3
• Return to work averages 5 days (range 3-16 days) for most patients 2
• Full activity resumption by day 10 is standard for segmental matrix excision procedures 3

Footwear Recommendations

• Wear comfortable, well-fitting shoes that avoid pressure on the surgical site 4
• Cotton socks are preferred to reduce friction 4

Monitoring for Complications

Signs Requiring Immediate Attention

• Active purulent drainage - while 44 of 62 patients in one series had pre-operative infection, post-operative infection requiring antibiotics is rare (approximately 2-3% incidence) 2, 3
• Increasing pain, redness, or swelling beyond the first few days 1
• Bleeding (occurs in approximately 1% of cases) 3

Important Caveat on Antibiotics

• Prophylactic antibiotics are NOT recommended - local gentamicin application showed no benefit in reducing infection rates or recurrence 5
• Only treat infection if clinical signs develop, which is uncommon 1, 2
• In the randomized trial, zero patients required antibiotics by two weeks regardless of post-operative care method 1

Expected Outcomes

Recurrence Rates

• Recurrence is rare with proper technique - expect 1-6.5% recurrence rates with partial matrix excision 2, 3
• If phenol was used for chemical matricectomy (rather than surgical matrix excision alone), recurrence rates are even lower 5
• Recurrence typically manifests within 3-7 months if it occurs 2

Functional Recovery Timeline

• Week 1: Significant pain reduction, keep bandage on 1
• Week 2: Minimal pain, normal function restored for most patients 1
• Day 10-12: Return to full normal activities 2, 3

Key Pitfalls to Avoid

• Do NOT recommend daily footbaths - this outdated practice increases infection risk without benefit 1
• Do NOT prescribe prophylactic antibiotics - they provide no benefit and contribute to resistance 5
• Do NOT allow premature return to tight footwear - this increases recurrence risk 4
• Be aware that patients with previous failed nail surgery (present in 16.6% of cases) may have heightened anxiety about recurrence 3