Nail bed lacerations

Nail bed lacerations

 

Complete nail bed injury

 

 

Anatomy Nail complex

 

1.  Nail Plate

 

2.  Nail Bed

- adherent to thin periosteum of P3

 

A.  Proximal germinal matrix

- proximal part

- limit is semilunar lunula

- produces 90% thickness of nail plate

 

B.  Sterile matrix

- adherent to nail plate

- contributes little to thickness

 

3.  Paronychium

- surrounding skin on dorsum of fingertip

 

4.  Eponychium 

- covers nail plate proximally

 

5.  Hyponychium

- thick skin below distal edge of nail

 

Options

 

1.  > 50% nail lost

- will get hook nail

- ablate nail bed

 

2.  < 50 % nail lost

- repair bed under magnification

- 6.0 chromic cat gut

- reduce nail plate back into fold to prevent adherence of dorsal and ventral folds

 

3.  Matrix defects

- can place nail bed material in place without sutures

- can use split thickness free nail bed graft

(i.e. from amputated digit)

 

4.  Proximal avulsion of nail plate

- always have germinal matrix laceration

- should always have 3 x horizontal mattress sutures

 

Suture v Glue

 

Strauss et al J Hand Surg Am 2008

- RCT 40 patients

- compare Dermabond to repair with 6-0 chromic suture

- no difference in outcome

 

Dorsal soft tissue defects

 

Complications

 

Hook Nail

 

Hook NailHook Nail

 

Subungual haematoma 

 

Management

- < 50% of nail bed -> Decompress with needle

- > 50% -> remove nail and repair bed