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I was having a debate today about dressings used in nail surgery and was wondering what other people do. When dressing the toe after performing nail surgery do you use an antimicrobial dressing, such as betadine spray or Inadine?

Myself and a few others think you should use one as it is an open wound however some others say that the phenol will kill anything on the toe. What do others think?

 

Hi Paul

I have always stuck with the way I trained 15 years ago, and that is bactigras immediately after surgery , then dry dressings only. I have had no problem with infection post op, and I now also allow the patient to get the wound wet from the next day. This has resulted in a slightly quicker healing time.

I am sure there will be plenty of other posters doing it their own way too so you will get many different protocols.

Cornmerchant.

 

I spent a while (nearly 20 years ago) using inadine, then switched to NA dressing and haven't used topical antiseptic preps since, I rarely see an immediate post op infection, I don't routinely get patients to use any such preps during the post op phase either, choosing systemic antibotics in the event of an infection. Having said that using a topical can sometimes help reduce stuck on dressings after TNA.

s

 

Paul,

To follow on from Cornmerchant's reply, I use Bactigras, kaltostat, sterile gauze, and tubinette to hold it all on the toe, (which is now the size of a Subway 6" Sub!!). I secure the Tubi' with Cutiplast at the base of the toe. I trained at GCU and SGH Glasgow in 2007, and this was the protocol we were taught then.

Cheers,

Nick.

 

G'Day all,

I'm of the camp that the phenol shoudl kill everyting in the area, and provided that good sterile technique is observed there shouldn't be too many problems with infection. I then dress with bactigras, melolin, tubular gauze and hypafix. I will add an aglinate dressing (either algisite or kaltostat) if there is a bit of post op bleeding or if I perform a TNA. I'll leave that on for about 3 or 4 days before I start redresings and rarely do I have any problems. Most of the post op issues I see are due to the patients getting the dressing wet, or getting the toe dirty, essentially poor patinet self care.

Cheers all!

 

I dont really see any need for anti microbial dressings. I used to use bactigras, kaltostst, lyofoam and a few other things but I dont think it made any differnce in their healing. Now I just give a good swab od betadine and dress with melolite. If they do have a raging infection prior to surgery they most likely will be on antibiotics.

Having said that most PNA i have done tend to be on male teenagers who heal very well. I may change my opinion if the patient were more at risk of infection and may be slow to heal.

 

Mark, you say you don't see the need for any anti-microbial dressings but you still apply Betadine. Have you found that not using this increases the risk of post op infection or is it something that you have always done?

I do think a lot of it depends on the patients that are being treated and the majority I have found are teenagers or young adults so should heal up quite quickly with little additional help.

 

Now that I think about it, applying betadine after PNA has just become a habit (or technique). Although, I usually dont recommend my patients applying betadine daily to the wound unless it is infected, a saline foot bath works just fine.