Algorithm for the management of antibiotic prophylaxis in onychocryptosis surgery

Area of Science:

• Podiatric surgery
• Infectious disease management
• Surgical prophylaxis

Background:

• Evidence for antibiotic prophylaxis in nail surgery is limited.
• Current practices do not clearly establish the need for antibiotics to prevent surgical site infections, joint infections, or endocarditis.

Purpose of the Study:

• To develop an evidence-based algorithm for antibiotic prophylaxis in onychocryptosis (ingrown toenail) surgery.
• To guide clinical decision-making regarding antibiotic use in this surgical context.

Main Methods:

• Comprehensive literature review of databases including Medline, Pubmed, Cochrane, and Scopus.
• Analysis of recent prospective studies and current authoritative guidelines.
• Consideration of a new classification system for onychocryptosis.

Main Results:

• Non-risk patients with early-stage onychocryptosis (Stage II-III) may undergo phenol matrixectomy without antibiotics.
• Advanced stages (IV-V) or long-standing cases require specific antibiotic treatment pre-surgery and management of infection/osteomyelitis.
• High-risk cardiac patients with infective onychocryptosis may need endocarditis prophylaxis.

Conclusions:

• Preoperative antibiotic prophylaxis is not routinely recommended for onychocryptosis surgery.
• Antibiotic use should be reserved for specific indications, including advanced infection and high-risk patient groups.