Nail Bed Lacerations

Subungual haematoma 

 

Management

- < 50% of nail bed -> Decompress with needle

- > 50% -> remove nail and repair bed

 

Nail bed lacerations

 

Options

 

1.  > 50% nail lost

- will get hook nail

- ablate nail bed

 

2.  < 50 % nail lost

- repair bed under magnification

- 6.0 chromic cat gut

- reduce nail plate back into fold to prevent adherence of dorsal and ventral folds

 

3.  Matrix defects

- can place nail bed material in place without sutures

- can use split thickness free nail bed graft

(i.e. from amputated digit)

 

4.  Proximal avulsion of nail plate

- always have germinal matrix laceration

- should always have 3 x horizontal mattress sutures

 

Complications

 

Hook Nail

 

Hook NailHook Nail