Wedge Resection

A wedge resection is performed for toenails that have recurrent infection. Most commonly the infection involves the big toe. The infection occurs because the toenail becomes ingrown into the nail fold.

Wedge resection surgery involves:

• General anaesthetic, intravenous antibiotics
• Oblique incision at base of toenail
• Excision of outer 1/5 of toenail
• Excision of outer 1/5 of germinal matrix (the cells that make new nail)
• Closure of wounds

All surgical procedures carry some risk. Fortunately the risk of complications with wedge resection surgery is extremely low. Some of the risks of surgery include:

• Recurrent infection
• Problems with wound healing
• Regrowth of a spicule of nail in the nail fold
• Deep venous thrombosis/pulmonary embolism (the risk of DVT increases with smoking, the oral contraceptive, hormone replacement therapy, immobility and obesity)
• Ongoing pain
• Anaesthetic complications
• Drug allergy

Rest

• You will have a cast on your leg. Keep foot elevated as much as possible, especially for initial 72 hours. Keep dressings dry and intact until post operative appointment.
• Mobilise short distances as pain allows, aim to remain in your own home for the first few weeks limiting long periods of standing or mobilising
• Do not bear weight for the first two weeks

Pain

• Pain relief may be required for up to 2 weeks; depending on your other medications this may include:
• Regular paracetamol, anti-inflammatory drugs and break through opiate type medications

Driving

• Any surgery performed on the right foot or both feet will mean no driving for a minimum of 2 weeks
• If surgery was performed on the left foot then driving in an automatic is possible, but Dr Phegan would recommend waiting a minimum of two weeks before attempting to drive

Driving any vehicle with a cast or boot is potentially hazardous and you should consider this before getting behind the wheel.

Follow up

• Keep all dressings dry and intact for the first two weeks
• Removal of stitches/sutures typically occurs at an appointment with Dr Phegan and his in-house therapists at 10-14 days at first post operative appointment. Very occasionally some sutures need to stay in for longer
• Your appointment will be booked by Dr Phegan and a confirmatory SMS will be sent informing you of the time and date for follow up

Typical milestones

• 1 week: wound check and dressing change
• 2 weeks: Wound review and removal of sutures
• 2-6 weeks: increase weight bearing as tolerated
• 6 weeks to 3 months: work on swelling reduction, scar massage and mobility
• Full recovery 3 months

Every patient's recovery is individual and depends on the severity of the injury and the complexity of the surgery.