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Post nail surgery dressing protocol

Discussion in 'Foot Surgery' started by zenjudo, Apr 10, 2011.

  1. zenjudo

    zenjudo Active Member


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    Hi guys,

    Just wondering what post op dressing protocol you use following nail surgery (partial or total nail avulsion/resection with phenol matrixectomy)?

    Do you debride the biofilm when you see them back for re dressing? Do you debride the wound everytime you see them back for re dressing?

    How early do you get the patient back for their first dressing?

    How many times do you re dress it for them? And how long between each dressing?

    How long do you normally get the patient to re dress their toe/s themselves?

    Just curious to see how everyone prescribe the post op dressing protocol as had talked to various people and searched online and found everyone practices differently, is there a "gold standard" approach?

    Cheers.

    Mike
     
  2. markleigh

    markleigh Active Member

    I see them one week post. op & generally that is all for a partial avulsion. For a total avulsion I MIGHT see them a 2nd time one week after.
    Dressing is almost always clean with hydrogen peroxide, Betadine & dressing. Have used it for 20 years with no concerns.
     
  3. W J Liggins

    W J Liggins Well-Known Member

    I use inadine dressings post op and have the patient seen at 4 days. If all is well, they are instructed to use NaCl foot baths daily with a plain clean gauze dressing until the wound has ceased to drain. I then see them myself 12 weeks post op for discharge.
     
  4. LucyPod

    LucyPod Active Member

    After nail surgery i usually dress the nail bed with atrauman, melolin x2, tube gauze & mefix. I will normally see the patient back the next day to ensure the patient is not in too much pain and that the nail bed has stopped bleeding. I would then normally dress the toe with inadine, melolin, TG & mefix. After this i would bring the pt back 1wk then 2wk, 4wk, 4wk & then discharge. In between appointments ensure the pt to redresses every other day after a saline foot bath and i give them a leaflet explaining how to redress their toe.

    Hope this helps
     
  5. drsarbes

    drsarbes Well-Known Member

    We usually redress with betadine ointment and telfa and gauze bandage.
    The patient removes this the next morning and begins bid soaks in a domeboro's type solution followed by a band aid. For totals we have the patient gentle rub the area (when symptoms allow, usually a few days) with wash cloth when bathing.

    We normally do not see them postoperatively unless they have an issue.

    Steve
     
  6. mburton

    mburton Active Member

    Hi Mike
    I was surprised to read here that hydrogen peroxide and gauze are still being used in connection with woundcare.

    I work for the NHS in Scotland and this has become my own routine over the years.

    Phenol will destroy any bacteria present so anti-bacterials shouldn't be necessary immed post-op. I apply a foam dressing post op, plus some fibres of alginate (Kaltostat) only if there is any significant post op bleeding. Review in 2-4 days.

    For routine care thereafter, pt advised to bathe as normal then remove wet dressing and replace with simple adhesive dressing such as Mepore (daily for first couple of weeks, stretching it out to alternate days thereafter if not too weepy) and advised to beware of infecting the wound by touching it with ANYTHING other than the new sterile dressing.

    I review partials in 1 month, totals in 2 months but I ask them to contact me if they are at all concerned.

    Hope this helps you, we all have our little ways!

    Mo
    Mo
     
  7. mburton

    mburton Active Member

    Sorry, should have added, I always debride any non viable tissue from wounds, including the biofilm that forms after phenolisations
     
  8. zenjudo

    zenjudo Active Member

    Thanks for all your posts guys, much appreciated.

    I guess with different wounds and different situations, there will always be variation to the dressing protocol.

    Cheers
    Mike
     
  9. markleigh

    markleigh Active Member

    I use the peroxide applied with a cotton tipped bud just to help clear away the exudate normally for one week post-op then apply Betadine. I've continued this same process for almost 20 years with low infection rates & very good overall results.
     
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