Nail Bed Laceration Anesthesia Key Figure 146 1 separate nail from nail bed using a straight hemostat. cleanse the wound thoroughly with saline. suture with a fine absorbable material (6 0 or 7 0 vicryl or dexon) ( figure 146 2 ). figure 146 2 the nail bed can be repaired after it has been fully exposed. replace the nail back into its normal anatomic position, as noted below. Nail bed injuries. nail bed repair tips and tricks. suture recommendations. 5 0 or 6 0 chromic; a spatulated needle may help pass through the nail bed tissue. permanent sutures are to be avoided as removal can be painful. suturing recommendations. follow the curve of the needle – failure to do so will tear the nail bed.
Nail Bed Laceration Anesthesia Key Any injuries involving the nail folds or proximal nail plate are especially concerning, as they can potentially jeopardize future nail growth and regeneration if not repaired adequately. 1,6,7 the van beek criteria offers a method to stratify nailbed injuries based on the precise location and extent of trauma (shown below). 8. Images. summary. nail bed injuries are the result of direct trauma to the fingertip and can be characterized into subungual hematoma, nail bed laceration, or nail bed avulsion. diagnosis is made by careful inspection of the nail bed integrity. treatment depends on severity and degree of nail bed injury but generally requires removal of the nail. Pearls. in children, general anesthesia is required to facilitate a meticulous repair. if the laceration involves only the distal portion of sterile matrix, the nail plate needs to be elevated only 1 to 2 mm beyond the laceration. examine the undersurface of the nail for any nail bed remnants. they can be used as a free graft. Roser se, gellman h. comparison of nail bed repair versus nail trephination for subungual hematomas in children. j hand surg [am]1999;24:1166–70. strauss e, weil w, jordan c, paksima n. a prospective, randomized, controlled trial of 2 octylcyanoacrylate versus suture repair for nail bed injuries. j hand surg am. 2008;33(2):250 253.
Nail Bed Laceration And Repair In The Emergency Department County Em Pearls. in children, general anesthesia is required to facilitate a meticulous repair. if the laceration involves only the distal portion of sterile matrix, the nail plate needs to be elevated only 1 to 2 mm beyond the laceration. examine the undersurface of the nail for any nail bed remnants. they can be used as a free graft. Roser se, gellman h. comparison of nail bed repair versus nail trephination for subungual hematomas in children. j hand surg [am]1999;24:1166–70. strauss e, weil w, jordan c, paksima n. a prospective, randomized, controlled trial of 2 octylcyanoacrylate versus suture repair for nail bed injuries. j hand surg am. 2008;33(2):250 253. Explore the nail bed thoroughly and suture any lacerations with 6 0 absorbable sutures. alternatively, you can use skin adhesive glue for the repair.12 if the patient’s nail plate is sufficiently intact, you should clean it and replace it between the eponychium (cuticle) and the nail bed in order to splint open the eponychium. this allows. Management. remove overlying nail, if present. repair lacerations using 5 0 or 6 0 absorbable sutures. replace nail into nail fold. trephination of the nail may be performed to allow drainage of blood. nail may be sutured into place. alternatively, a nail shaped adaptic or non adherent gauze may be placed under the nail fold.
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