Postoperative dressing regimens in nail surgeries: a scoping review

Background: Toenail surgeries are one of the most common surgeries performed on the lower limb with many common postoperative complications, including prolonged healing time, infection and prolonged exudation. There is a wide variety of dressings designed to reduce the rate of postoperative complications and improve healing. The efficacy of dressings for improving postoperative healing in toenail surgeries is still unknown. There is no consensus on the correct dressing regimen and a low number of studies into the subject. This review aimed to assess the current literature to determine the most efficacious postoperative dressing regimens following toenail surgeries. Methods: Searches were conducted in MEDLINE, Embase, CINAHL, Cochrane library and SCOPUS from database creation to June 2025. Quantitative studies which applied any postoperative dressing regimen to any patient undergoing any form of toenail surgery and attributed the postoperative outcome to the dressing were deemed eligible for inclusion. Two independent reviewers performed the study selection, data extraction and risk of bias assessment. Risk of bias was assessed using the JBI critical appraisal tools. Results: Fourteen studies met the inclusion criteria. The included studies had 27 dressing regimens across 15 outcome measures. Outcome measures investigated were as follows: pain, healing rate, time of exudate, inflammation, infection rate, bleeding, size of exudate, type of exudate, soothing effect, nail area preservation, time until normal shoe wear, satisfaction rate, time until full function, ease of removal by dressing type and ease of dressing removal by surgery type. Overall, no outcome measure had high quality evidence supporting use, suggesting no dressing was superior to others for any of the outcome measures. Conclusions: Collation of similar outcome measures was not possible due to the variability in outcome measures, and a lack of high-quality studies investigating the efficacy of specific dressing regimens for the reduction of postoperative complications or improving postoperative healing meant specific conclusions could not be formed. However, a consensus in the included articles was that primary dressings were more likely to impact postoperative outcomes when compared to secondary dressings. Further high-quality research investigating the efficacy of postoperative dressing regimens in nail surgery are needed.