Post-Operative Care After Ingrown Toenail Surgery: Keep It Dry
Keep the surgical site dry and covered with a protective dressing for at least 48 hours post-operatively, rather than soaking in Epsom salts, to minimize infection risk. 1
Evidence-Based Wound Management
The available evidence strongly supports keeping surgical wounds dry in the immediate post-operative period:
- Surgical wound dressings should remain undisturbed for a minimum of 48 hours after surgery unless leakage occurs, as recommended by postoperative care bundles for infection prevention 1
- There is no evidence that advanced dressings provide additional benefit over standard dressings for primarily closed surgical wounds, and the focus should be on maintaining a protective barrier 1
- The WHO Global Guidelines for the Prevention of Surgical Site Infections found that covering surgical wounds healing by primary intention does not necessarily reduce SSI risk, but maintaining the dressing for 48 hours is standard practice 1
Why Soaking Is Not Recommended Post-Operatively
While Epsom salt soaks are mentioned in older literature as part of initial conservative treatment for ingrown toenails before surgery 2, the post-operative context is entirely different:
- Once a surgical incision is made, the wound creates a potential portal for bacterial entry 3
- Soaking introduces moisture that can macerate the wound edges and compromise the protective barrier 1
- The surgical site needs to remain sealed until epithelialization occurs, typically within 48-72 hours 1
Optimal Post-Operative Protocol
For the first 48-72 hours:
- Keep the dressing dry and intact 1
- Elevate the foot to reduce swelling
- Monitor for signs of infection: increasing warmth, erythema extending beyond 2 cm, purulence, or systemic symptoms 4
After 48-72 hours:
- The dressing may be removed if no leakage has occurred 1
- Gentle cleansing with clean water or saline is appropriate once the wound is sealed 5
- Apply a fresh protective dressing if needed 1
Critical Infection Prevention Measures
Beyond keeping the wound dry, other evidence-based strategies to minimize infection include:
- Preoperative skin antisepsis with alcohol-based chlorhexidine solution (not post-operative soaking) 1
- Appropriate perioperative antibiotics if indicated for contaminated cases 1
- Proper surgical technique including glove changes before closure 1
When Soaking May Be Appropriate
The historical recommendation for Epsom salt soaks applies to conservative management of ingrown toenails without surgery 2, 6, or potentially after complete wound healing (typically 2-3 weeks post-operatively). However, in the immediate post-operative period, this practice contradicts modern wound care principles.
Red Flags Requiring Urgent Evaluation
Seek immediate medical attention if any of these develop:
- Increasing pain, warmth, or redness beyond the immediate surgical area 4
- Purulent drainage or foul odor 1
- Fever or systemic symptoms 1
- Signs of tissue necrosis or gangrene (rare but reported) 3
Common Pitfall to Avoid
Do not confuse pre-operative conservative management recommendations with post-operative wound care. The older literature describing Epsom salt soaks refers to non-surgical treatment approaches 2, 6, not post-operative care after nail avulsion or matricectomy procedures.