5 Nailbed Repair


5 Nailbed Repair

Dariush Nikkhah, Jeremy Rodrigues

5.1 Nailbed Injuries

Pediatric nailbed injuries are commonplace in many hand surgery units (Fig. 5‑1). Adults can be operated on under local anesthesia, but in young children, general anesthesia is needed.

If there is evidence of subungual hematoma, or the nail has been partially avulsed, exploration and repair is usually warranted (Fig. 5‑2, Fig. 5‑3, Fig. 5‑4, Fig. 5‑5). Many of these injuries have tuft fractures that can be managed conservatively. Some surgeons have advocated that the nail plate should not be placed back after repair, due to a possible higher risk of infection, although the nail plate can act as a splint for some fractures of the distal phalanx and may prevent the formation of synechiae. If replaced, the nail plate can be secured with a simple figure of 8 stitch using Vicryl Rapide. Tissue glue can cause problems with prolonged adherence of the old nail plate, in the author’s experience.

Fig. 5.1 Right thumb nailbed injury in a 2-year-old child.
Fig. 5.2 Nail plate is lifted with Mitchell’s trimmer; this prevents inadvertent removal of sterile matrix. After sufficient release, Stevens’ tenotomy scissors can be used to lift off the nail plate.
Fig. 5.3 The nail plate can then be grasped on one side with a mosquito clamp and peeled off slowly avoiding injury to the underlying sterile matrix.
Fig. 5.4 Once the nailbed is washed, and hematoma is removed, one can repair the sterile matrix with 6.0 or 7.0 braided absorbable suture such as Vicryl Rapide. The sterile matrix is important for contact adherence. The new nail forms from the germinal matrix, which contributes 90% growth of the nail.
Fig. 5.5 Finger bob dressing applied after removal of tourniquet. Underneath this, a nonadherent silicone primary dressing is used as it will be left in situ for several days.

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May 21, 2020 | Posted by in Hand surgery | Comments Off on 5 Nailbed Repair
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