Managing Nail Bed Injuries: Post-Surgery Care and Recovery Tips - Surgery

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Management of paronychia wound?


I had about half of my big toenail removed in the hospital.
When I went for a dressing change the next day, the doctor placed a grid-like object over the wound before wrapping it in gauze.
The doctor explained that this is to protect the nail bed from adhering to the cotton.
It can be removed once there are no blood stains on the cotton during the dressing change.
Today is the fifth day, and there is only a small amount of blood on the cotton that needs to be changed.
When I cleaned the wound with saline and a cotton swab, there was also a little blood on the swab.
Should I remove the grid-like object? It seems to be sticking a bit tightly to my wound, and besides the blood, there is also some yellowish discharge (I'm not sure if it's exudate).
Additionally, my entire big toe is still slightly swollen and looks a bit bruised at this point (fifth day).
Is this a normal phenomenon? Thank you.

Miss Zhou, 10~19 year old female. Ask Date: 2020/07/11

Dr. Li Zhonghuai reply Surgery


Hello! You can use either a gauze dressing or antibiotic ointment.
However, it is recommended to change the dressing daily, and applying the ointment thickly will prevent it from sticking to the gauze.
Elevate your foot while sleeping, and the swelling should subside in a few days.
Take care! Changhua Hospital cares about you!

Reply Date: 2020/07/11

More Info


Managing nail bed injuries, especially after surgery, requires careful attention to ensure proper healing and to minimize complications. In your case, where a significant portion of your big toe nail was removed, it’s essential to follow specific guidelines for post-surgery care.

Firstly, regarding the grid-like object placed over your nail bed, this is likely a protective measure to prevent the dressing from adhering to the wound. It’s common for such materials to be used to allow airflow while protecting the area from external contaminants. If you notice that the grid is sticking to your wound, it’s crucial to handle it gently. You should not forcibly remove it if it is adhering to the tissue. Instead, you can try to moisten it with saline solution to help loosen any adhesion. If the grid is causing significant discomfort or if you see signs of infection (such as increased redness, swelling, or discharge), you should contact your healthcare provider for further evaluation.

As for the slight bleeding and the presence of yellowish fluid on the cotton, this can be normal in the healing process. The yellowish fluid may be serous fluid, which is a part of the body’s natural healing response. However, if the discharge becomes thick, foul-smelling, or changes color significantly, it could indicate an infection, and you should seek medical attention.

The swelling and bruising you are experiencing in your toe are also common after such an injury. Swelling can persist for several days to weeks, depending on the extent of the injury and your body’s healing response. Bruising is a result of blood vessels breaking under the skin and is typically a normal part of the healing process. However, if the swelling increases or if you experience severe pain, it could indicate complications such as hematoma formation or infection.

Here are some additional tips for managing your recovery:
1. Keep the Area Clean and Dry: Continue to clean the wound gently with saline or as directed by your healthcare provider. Avoid soaking the area in water until you receive clearance from your doctor.

2. Monitor for Signs of Infection: Keep an eye on the wound for any signs of infection, such as increased redness, warmth, swelling, or discharge that is yellow or green. If you notice any of these symptoms, contact your healthcare provider immediately.

3. Pain Management: If you are experiencing pain, over-the-counter pain relievers such as acetaminophen or ibuprofen can be helpful. Always follow the dosage instructions on the label or those provided by your healthcare provider.

4. Elevation: To help reduce swelling, try to keep your foot elevated when resting. This can help minimize fluid accumulation in the area.

5. Follow-Up Appointments: Attend all scheduled follow-up appointments with your healthcare provider. They will assess the healing process and determine when it is appropriate to remove any protective dressings.

6. Avoid Pressure: Try to avoid putting pressure on the injured toe as much as possible. If you need to walk, consider using supportive footwear that does not put pressure on the toe.

7. Nutrition: Ensure you are eating a balanced diet rich in vitamins and minerals, particularly vitamin C and protein, which are essential for wound healing.

In conclusion, while some swelling and bruising are normal after a nail bed injury, it’s essential to monitor your symptoms closely. If you have any concerns about the healing process or if you notice any unusual changes, do not hesitate to reach out to your healthcare provider for guidance. Proper care and monitoring are key to a successful recovery.

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