- See:
-
Distal Phalangeal Frx:
-
Finger Tip Injuries:
-
Ingrown Toe Nail
-
Paronychia:
-
Matriectomy:
-
Mucous Cyst:
-
Nail Bed Biopsies:
- Anatomy: -
nail plate:
- comprised of concentrated, adherent interdigitating cells which have no nuclei or organelles;
-
germinal matrix:
- comprised of cells which contribute to 90% growth of the new nail;
- distal edge of the germinal matrix is demarcated by the edge of lunula;
- there is minimal adherence of germinal matrix to the nail;
-
sterile matrix:
- extends distal to the lunula;
- responsible for adherence of nail to nail bed;
- Nail Bed Injuries:
- w/ nail bed injuries, especially crushing ones, may seem innocuous but must be treated appropriately to minimize subsequent deformity;
- force of flat nail is transmitted to prominence of underlying tuft, concentrating the pressure in that area, causing a bursting
laceration to occur in the nail matrix;
- Treatment: Nail Plate Intact:
- recognition of nail bed laceration can be difficult, but the acute setting is the best opportunity to avoid deformity;
- consider exploration of the entire nail bed if a subungual hematoma involving more than 25% of the nail is present esp if
frx is present;
- nail is removed & matrix carefully sutured;
-
Treatment: Nail Bed Avulsed:
- nail bed laceration is visible;
- need for repair of the nail bed is clearly evident;
- consider insertion of petroleum gauze between the nail fold and the matrix to prevent adhesions;
- Nail Bed Injuries w/ Distal Phalangeal Frx:
- see:
distal phalangeal frx:
- crushing injuries may cause fractures, with or w/o soft tissue injury;
- small, non displaced tuft frx do not require treatment;
-
diaphyseal frxs often result in angulation & malalignment, which may
result in considerable deformity;
- often these frxs can be simply stabilized by suturing the skin of the lateral nail folds;
- more unstable frxs need to be stabilized w/ K wires;
- note that base of nail bed and soft tissue may become entrapped in frx site;
- commonly seen where the root of the nail has been avulsed from beneath the proximal nail fold;
- if this is not adressed nonunion of the fracture may result;
- Preop Considerations:
- Techique of Total Nail Plate Avulsion:
- Repair Technique:
-
exposure of nail matrix and nail fold
- indicated only for proximal nail injuries;
- if the lateral cuticle has been injured, repair it first (w/ 5-0 nylon) inorder to align the rest of the nail;
- nail bed laceration is then carefully re-approximated w/ 6-0 or 7-0 chromic or Vicryl Sutures;
- w/ proximal avulsion of the germinal matrix, direct suture repair can be difficult;
- consider placing a horizontal matress suture thru each corner of the of the germinal matrix which is then passed upwards thru
the lateral ends of the epinychial corners;
Nail bed repair and reconstruction by reverse dermal grafts.
Treatment of subungual hematomas with nail trephination: a prospective study.
Injuries to the nail bed in childhood.
Anatomy and physiology of the perionychium: a review of the literature and anatomic study.
Study of Nail Bed Injuries: cause, treatment, and prognosis. Zook E.G., Guy R.J., Russel R.C., J. Hand Surg. 1984; 9A: 247-252.
A Prospective, Randomized, Controlled Trial of 2-Octylcyanoacrylate Versus Suture Repair for Nail Bed Injuries
