What are the aftercare directions for a healthy adult patient following an ingrown toenail resection?

Aftercare Following Ingrown Toenail Resection

Immediate Post-Procedure Wound Care

Keep the surgical site clean and dry, changing dressings daily with gentle cleansing using sterile water or 0.9% sodium chloride solution, and apply a non-occlusive breathable dressing to prevent maceration while monitoring for signs of infection. 1

Daily Wound Management (First Week)

• Cleanse the wound daily with sterile water, freshly boiled and cooled water, or 0.9% sodium chloride solution to remove debris 1
• Apply a sterile Y-dressing or non-fiber-shedding compress under any external dressing, ensuring no tension is placed on the surgical site 1
• Avoid occlusive dressings as they create a moist environment that promotes skin maceration and increases infection risk 1
• Monitor daily for infection signs including increased pain, erythema, purulent drainage, warmth, swelling, or induration 1, 2

Pain and Inflammation Control

• Soak the affected toe in warm water with Epsom salt for 15-20 minutes twice daily to reduce inflammation and promote healing 3, 4
• Apply a mid- to high-potency topical steroid ointment after soaking to reduce inflammation and edema 2, 4
• Use over-the-counter analgesics as needed for pain control 5

Transition to Maintenance Care (After One Week)

Once the surgical site shows proper healing (typically after 7 days), transition to less intensive care 1:

• Reduce cleansing frequency to twice weekly using clean tap water and soap 1
• Dry the area gently and thoroughly after each cleaning 1
• Showering and bathing are permitted once the wound is well-healed, typically after a few weeks 1

Infection Prevention and Management

Signs Requiring Immediate Medical Attention

If infection develops—evidenced by increased pain, redness, swelling, purulent drainage, or warmth—initiate oral antibiotics with coverage against Staphylococcus aureus and gram-positive organisms immediately. 2, 6

Antibiotic Selection if Infection Occurs

• First-line options include: cephalexin (first-generation cephalosporin), amoxicillin-clavulanate, clindamycin, or doxycycline 2, 6
• Obtain bacterial cultures if pus is present before starting antibiotics to guide therapy 2, 6
• If abscess develops, drainage is mandatory before antibiotic therapy 6

Long-Term Prevention Strategies

Proper Nail Care Education

• Trim toenails straight across rather than curved to prevent recurrence 1, 7
• Keep nails as short as possible without cutting into the nail bed 1, 6
• Avoid sharing toenail clippers with family members to prevent fungal transmission 1, 6

Footwear and Hygiene

• Wear properly fitting footwear that accommodates the shape of the feet without excessive pressure 1
• Manage hyperhidrosis with absorbent powders containing antifungal agents (miconazole, clotrimazole, or tolnaftate) in shoes and on feet 1, 4
• Wear cotton, absorbent socks and change them regularly 1
• Consider discarding old footwear that may harbor fungal elements, or treat shoes with antifungal spray 1

Daily Self-Monitoring

• Examine the surgical site daily for any signs of recurrence or complications 1
• Contact a healthcare professional immediately if signs of infection, recurrent ingrowth, or persistent pain develop 1, 2

Common Pitfalls to Avoid

• Do not apply excessive tension to dressings or the surgical site, as this impairs healing 1
• Avoid premature return to activities that place pressure on the toe before adequate healing 5
• Do not use prophylactic antibiotics routinely for clean surgical wounds without signs of infection 2
• Reassess after 2 weeks if infection develops to determine if oral antibiotics and local care are effective, or if surgical intervention is needed 2, 6