II. Associated Conditions
III. Management: Native Nail vs artificial stent
- Retain the native nail (best option)
- Acts as a splint to hold open eponychial and protects the nail bed
- Avoid artificial nail splints due deformity risk and infection (use the native nail instead)
- Native nail not available (lost or destroyed)
- Use a nail substitute (e.g. foil from Suture pack cut to size)
- Inserted under the eponychial fold to prevent scarring, closure
- However, nail stenting has been found to slow healing with higher infection risk
- Use a nail substitute (e.g. foil from Suture pack cut to size)
IV. Management: Nail Replacement
- Reattach partially avulsed or fully avulsed nails
- Option 1: Tack down nail edge at each Paronychial fold
- Consider pre-drilling holes (e.g. cautery, #18 gauge needle) in a thick nail to allow Suture to more easily pass
- Hold nail in place with a 1-2 Sutures through nail and the adjacent lateral nail folds (Paronychial fold)
- Risk of nail sliding out from the eponychial fold (proximally) and Paronychial folds (laterally)
- Option 2: Transverse figure of eight technique
- Indicated for nail reattachment
- Soak the nail in warm saline for 15 minutes
- Cut two 1 mm wedges into the distal nail edge (similar to the top of a king's crown)
- Suture the nail to hold it in place
- Place first Suture throw adjacent to one lateral nail edge, from distal to proximal
- Pull the Suture from proximal nail edge, across the nail diagonally to distal notch
- Thread the Suture around the distal nail to the second notch
- Place the second Suture throw from the other lateral nail edge, from distal to proximal
- Pull the Suture from the proximal nail edge across the nail diagonally to the start of the Suture
- Tie off the Suture
- Resources
- Closing the Gap: Wound Closure for the Emergency Practitioner
- References
- Option 3: Tissue Adhesive
- Replace intact nail back within the folds of the fingertip
- Dry the edges carefully
- Apply Tissue Adhesive at the nail fold edges to secure in place
- Lin in Herbert (2015) EM:Rap 15(2): 6-7
V. Management: Subungual Trauma
- See Nail Bed Laceration
- See Subungual Hematoma
- Nail Bed Repair Indications
- Subungual Hematoma >50% of nail bed AND
- Nail detached or surrounding tissue disrupted (especially at proximal nail at the germinal matrix)
VI. References
- Lin and Lin in Herbert (2014) EM:Rap 14(11): 8-10
- Lin, Gajendran and Orman in Herbert (2016) EM:Rap 16(11): 7-8