What are pearls for nail bed laceration repair?

Updated: Aug 25, 2020
  • Author: Rahi K Yallapragada, MBBS, MRCS, FRCS(T&O), MCh(Orth); Chief Editor: Erik D Schraga, MD  more...
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Answer

Answer

Trephination alone without nail removal and laceration repair may be adequate in the setting of a subungual hematoma with an intact nail plate.

Some suggest elevating and retracting the nail plate rather than removing it completely to facilitate the nail bed repair.

All retrievable fragments of nail bed should be replaced as free grafts. A graft of 1 cm in diameter will usually live by inosculation and ingrowth of circulation from the periphery, even on the bare cortex of the distal phalanx.

The nail plate can be repaired using tissue adhesives such as Indermil (n-butyl cyanoacrylate) or Histoacryl (2-butyl-cyanoacrylate), which contain no toxicological hazard. [6, 7] The same glue can be used instead of a stitch to secure the nail to nail bed and hyponychium.


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