Postoperative infection after excisional toenail matrixectomy: a retrospective clinical audit.

BACKGROUND: Excisional toenail matrixectomies are performed on the area of the foot that has been reported to have the highest concentration of resident microorganisms. A retrospective infection audit was performed to identify whether this unique area of the foot was more susceptible to postoperative infection.

METHODS: A retrospective audit reviewing the postoperative infection rate over a 6-year period after excisional nail matrixectomy in 111 patients was undertaken.

RESULTS: The postoperative infection rate was found to be high (18.9%) relative to that of clean orthopedic foot and ankle surgery (0.5%-6.5%).

CONCLUSIONS: The unique concentration of resident microbes found in the nail folds could help explain the high rate of postoperative infections identified in this study. This may provide some argument to classify excisional nail matrixectomy as clean-contaminated surgery and, thus, warrant routine antibiotic prophylaxis. Further research is recommended to confirm the results of this study and to determine whether appropriately timed oral antibiotic prophylaxis will reduce the infection rate after nail surgery.