Should I Remove My Toenail After Surgery or Let It Fall Off Naturally?

The doctor lifted and removed the toenail and then covered it back up?

Last week, I kicked a board and completely lifted off my toenail.
The emergency doctor removed the nail, cleaned the area, and then placed the nail back on and stitched it up to protect the nail bed.
I was advised to have the stitches removed and then take off the nail.
I was also told that I could go to a nearby clinic for follow-up care.
However, when I went to the nearby clinic to have the stitches removed, the doctor did not remove the nail and said it would fall off naturally.
I informed the clinic doctor that the emergency doctor had said to remove it after the stitches were taken out, but the clinic doctor insisted it was unnecessary.
I'm unsure what to do now.
The main issue is that the nail was completely removed initially, and it was just placed back on.
I also noticed that the nail seems to be stuck, and I'm afraid to pull it off, but I'm worried that leaving it on might affect the healing of the wound or the future growth of the nail.
I would like to ask the doctor if I should remove the nail.

Han, 20~29 year old female. Ask Date: 2017/09/30

Dr. Ke Fangxu reply Surgery

Actually, it would have been more straightforward to remove the entire nail at the beginning.
If it were to be put back, even if it adhered, it would only be temporary.
Now that a week has passed, the wound should be mostly healed.
You can try to gently lift it; if it comes off easily, you can remove it completely.
If it cannot be removed, I can only suggest that you wait for the new nail to grow out, at which point the old nail will naturally fall off.

Reply Date: 2017/09/30

More Info

When it comes to the management of a toenail that has been partially or completely removed due to trauma, there are several important considerations to keep in mind. In your case, since the emergency doctor removed the toenail and then sutured it back in place to protect the nail bed, it is crucial to follow up with the appropriate care to ensure proper healing.

Understanding the Situation
1. Initial Trauma and Treatment: You mentioned that your toenail was completely lifted off after kicking a board. This type of injury can be quite painful and may lead to complications if not managed properly. The emergency physician's decision to remove the nail and cover the nail bed was likely made to prevent infection and promote healing.

2. Follow-Up Care: After the initial treatment, it is common for patients to be advised on how to care for the area. In your case, the emergency doctor instructed you to have the nail removed after the stitches were taken out. However, the doctor at the follow-up clinic suggested that the nail could fall off naturally.

Should You Remove the Toenail?
- Natural Shedding vs. Surgical Removal: In many cases, if a toenail has been partially removed and is still attached to the nail bed, it may be best to allow it to fall off naturally. This is because forcibly removing a nail that is still somewhat attached can cause additional trauma to the nail bed, potentially leading to complications such as infection or improper nail growth in the future.

- Signs to Watch For: If the nail appears to be firmly adhered to the nail bed and is not causing you significant pain, it may be best to leave it in place. However, you should monitor for signs of infection, such as increased redness, swelling, pus, or worsening pain. If you notice any of these symptoms, it would be wise to consult a healthcare professional.

- Impact on Healing: Keeping the nail in place can provide a protective barrier for the nail bed as it heals. If the nail is not causing any issues and is not infected, it may actually aid in the healing process. However, if you feel that the nail is causing discomfort or is not healing properly, you should seek medical advice.

Recommendations
1. Consult a Specialist: If you are uncertain about the best course of action, it may be beneficial to consult a podiatrist or a specialist in foot care. They can assess the condition of your toenail and nail bed and provide tailored advice.

2. Follow-Up Care: Continue to keep the area clean and dry. If you have been given any specific instructions regarding wound care, be sure to follow them closely.

3. Pain Management: If you experience pain, over-the-counter pain relievers may help. However, consult with a healthcare provider if the pain persists or worsens.

4. Future Nail Growth: If the nail does fall off, it may take several months for a new nail to grow back fully. During this time, protect the nail bed from injury and keep it clean.

In conclusion, whether to remove the toenail or allow it to fall off naturally depends on its current state and any symptoms you may be experiencing. If in doubt, seeking a second opinion from a foot specialist can provide clarity and ensure that you are taking the best steps for your recovery.

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