Salvaging an Avulsed Nail Bed With Free Grafting and Cooling

Abstract and Introduction

Abstract

Most nail bed injuries occur along with other fingertip injuries; however, isolated total avulsion injuries of the nail bed are uncommon. To obtain optimal results, reconstructive methods should be selected judiciously depending on the type of injury, the patient's needs for their economic status and postoperative aesthetics, and postoperative morbidities. Replantation with an avulsed nail bed, if feasible, can be a reasonable treatment option to avoid the morbidities of other donor sites. This report presents a rare case of a 26-year-old man who experienced an isolated total avulsion injury of the nail bed with exposure of the phalangeal bone while using machinery, which was treated successfully with free grafting and postoperative ice cooling

Introduction

Nail bed injuries often are associated with fingertip injuries and pose a surgical challenge because inadequate management can result in irregular and nonadherent nail deformities. Depending on the type of injury, various treatment modalities can be considered. Traditionally, nail bed defect treatment is size-dependent, and management may involve healing by secondary intention or nail bed grafting. For avulsion injuries of the nail bed, a split-thickness graft harvested from an uninjured portion of the involved finger^[1] or a greater^[2,3] or lesser toe^[4] has been preferred over other repair methods to avoid nail deformities and ensure natural nail growth. However, studies have reported that nail bed grafting is not necessary due to the regenerative potential of the nail bed.^[5,6] The nail bed obtained from an amputated part also can be used as donor tissue to repair nail bed defects. When the avulsed nail bed is in suitable condition for grafting with adequate preservation, replantation should be considered first to avoid morbidities of other donor sites.