Nailbed

[brainfailure]

So I had a finger lac that started at the lateral nailfold and extended into the nail. The nail was securely on, but it was cut. The cut did not go all the way to the other side (ie to the other nail fold). I seem to remember reading somewhere that if you think there's a nailbed lac, it probably does OK without you doing anything, especially if the nail is still on and taking off the nail to fix it is probably overkill. I don't remember where I read that, though. Anybody remember coming across something like that? The Roberts procedure book doesn't mention it.

Anyhow, I have the luxury of sending this guy to hand in 2 days, so I irrigated the heck out of it, splinted it and sent it home.

Any insights?

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[BklynWill]

It sounds like there was enough structural integrity to warrant the conservative management. Not all of the non-complex nail injuries need to be sutured (except maybe the skin lateral to the nail). I've had some good success with poking holes on each side of the nail lac with cautery and throwing ties through with absorbable sutures without having to remove the nail- even on complex repairs.

 

[DocZ]

Just curious, what would you have done if that same injury was a toe lac instead?, how about complex nailbed injuries on toes?

 

[ORL10]

Generally for nail bed repairs, if I am going to be meticulous about it, I will remove the nail plate, irrigate the nail and either suture the nail bed laceration with chromic gut (5 or 6-0) or use dermabond, and then replace the proximal nail (depending on its viability, whether or not it is a crush injury vs avulsion or simple laceration) which will act as a splint. Then cover it and have them follow-up with hand. I snagged this from my days as a "future plastic surgeon" turned ED doc on several of my rotations where nail bed lacs were pretty common place.

This is a pretty good reference for management
http://www.smbs.buffalo.edu/ortho/residency/uosjournal/nailbed.pdf

and pretty much anything written by elvin zook out of SIU hand.