Occasionally, nailbed lacerations are caused by a cutting rather than a crush mechanism. In these cases, I use a different technique. I leave the fingernail on. In fact, I use the fingernail to help reapproximate the nailbed edges.
Trick of the Trade:
Nailbed repair through fingernail
This technique requires that the fingernail has a simple linear laceration through it. The fingernail has to be relatively still adherent to the nailbed. The case below is a patient who sustained a fingertip laceration with an industrial skill saw.
- Carefully perform a distal neurovascular exam.
- Perform a digital nerve block of the finger.
- Copiously irrigate the laceration because this is almost always an open fracture.
- Carefully create 2 holes (blue arrows) in the fingernail on either side of the laceration using electrocautery. Be careful not to injure the nailbed.
- Suture the fingernail back together by placing a non-absorbable, simple interrupted suture through the two fingernail holes. There is no need to puncture through the nailbed. Reapproximating the fingernail should also pull the nailbed edges together.
- Remove the sutures after 7-10 days.
Here is a follow-up photo of the same patient who returned 72 hours later for a wound check. Although the photo is a little fuzzy, you can see that the wound was healing well.
Advantages of this technique:
- Less traumatic repair of the nailbed
- Preservation of the eponychial fold because the native fingernail remains in place. A new fingernail can grow out normally.
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