Thanks to Dr. Wang for presenting today’s Morning Report!
Nailbed Injuries
- Typically caused by crush injuries with hammer, in doorway, or car doors. Trauma by saws, knives, or drills can also cause these injuries
- Subungual hematoma: 50% have underlying nailbed laceration
- Nailbed injuries: nailbed lacerations
- Workup includes xrays to rule out fracture. 50% of nailbed injuries have associated fractures
- Repair
- Subungual hematoma: trephination
- Nail plate avulsion
- Digitally block with 1% lidocaine without epi
- Tourniquet the finger for blood-free field
- Remove nail: elevate/separate nailplate from nailbed with iris or fine scissors. DO NOT cause further damage to nail bed. Use hemostat gently remove nail.
- Nailbed laceration is repaired with 6-0 absorbable sutures
- Use native nail (if you can) as a stent to keep the nail fold open for new nail growth
- Use aluminum suture packing as splint if native nail not available
- Place native nail or splint into the nail fold and suture in place with 5-0 or smaller nylon
- Distally through the hyponychium and nail
- Through paronychia and nail bilaterally
- Through the nail and proximal nail fold
- Horizontal mattress through proximal nail fold
- Dorsal figure of eight suture (spork method)
- Dermabond can be used
- Dress with non-adherent gauze
- Consult hand if significant avulsed matrix or severe crush injury
- Tetanus, Pain control
- Follow up in 2-3 days for wound check. Sutures to be removed after 2-3 weeks.
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Jay Khadpe MD
- Editor in Chief of "The Original Kings of County"
- Assistant Professor of Emergency Medicine
- Assistant Residency Director
- SUNY Downstate / Kings County Hospital
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