What is the procedure and post-operative care for an onychectomy (nail removal surgery)?

Onychectomy (Nail Removal Surgery): Procedure and Post-Operative Care

For nail removal surgery, maintain an occlusive dressing undisturbed for 48 hours post-operatively, use topical antibiotics routinely, provide multimodal analgesia with topical anesthetics and NSAIDs while avoiding opioids, and schedule follow-up at 7 days for wound assessment and 4 weeks for healing confirmation. 1

Immediate Post-Operative Management (Day 0-2)

Wound Dressing

• Apply an occlusive or semi-occlusive dressing in the operating room and leave it in place for a minimum of 48 hours unless visible leakage, bleeding, or soiling occurs 1
• Use either sterile gauze or sterile transparent semi-permeable dressings to cover the surgical site 1
• If transparent dressings are used, they allow continuous visual inspection without removal and can remain in place up to one week unless they become damp, loose, or visibly soiled 1

Pain Management

• Provide topical anesthetic sprays or ointments as first-line pain control 1
• Administer acetaminophen and NSAIDs for systemic pain relief 1
• Avoid opioid analgesics due to potential complications including constipation and urinary retention 1
• Apply local cool packs to the surgical site for additional pain relief 1

Infection Prevention

• Administer topical antibiotics routinely in the immediate post-operative period 1
• Use proper hand antisepsis and aseptic non-touch technique when changing dressings 1
• Apply 0.5-2% alcoholic chlorhexidine solution during dressing changes for skin antisepsis 1

Urinary Function Monitoring

• A Foley catheter should remain in place given the increased risk for urinary retention 1
• Perform a voiding trial on postoperative day 1 to ensure adequate bladder function 1

Early Post-Operative Period (Days 3-7)

Wound Care

• After the initial 48-hour period, perform daily incision washing with chlorhexidine to prevent surgical site infections 1
• Change dressings using sterile technique if exudate, bleeding, or soiling is present 1
• Document wound healing progress and any concerns at each assessment 1

Complication Surveillance

• Monitor for signs of infection including redness, increased pain, purulent drainage, or fever 1
• Evaluate for postoperative complications within 2 weeks by the operating surgeon, looking specifically for signs of infection, skin necrosis, or loss of surgical integrity 2
• Instruct patients to seek immediate medical attention if any infection signs develop 1

Follow-Up Schedule

Week 1 (Day 7)

• Conduct wound assessment to evaluate healing progress 1
• Check for early complications including infection (reported in 11.6% of cases), hemorrhage, or excessive pain 3

Week 2

• Perform surgical complication check by the operating surgeon 2
• Assess for delayed complications such as regrowth or persistent inflammation 3

Week 4

• Confirm complete healing of the surgical site 1
• Document final outcome and address any residual concerns 1

Patient Education and Documentation

Documentation Requirements

• Clearly document the procedure performed, including comprehensive details on the technique used 1
• Provide patients with a written record of their procedure for future medical care 1

Patient Instructions

• Inform patients of the importance of close follow-up and adherence to wound care instructions 1
• Educate patients on signs of infection requiring immediate medical attention 1
• Emphasize the need to keep the dressing dry and intact for the first 48 hours 1

Common Pitfalls and Caveats

Early dressing removal is a critical error—removing the dressing before 48 hours increases infection risk and disrupts the healing environment 1. The most common complications include infection (11.6%), pain (38.1%), and hemorrhage (31.9%), with infection rates varying by technique used 3. Silver nitrate chemical matricectomy after partial onychectomy shows lower recurrence rates (4.7%) compared to electrocautery (11.2%) and should be considered as an alternative approach 4.