From the Research
The best management approach for a complete nail avulsion involves immediate wound care, meticulous nailbed repair, and appropriate follow-up, prioritizing techniques that minimize trauma to adjacent tissue, as described in the most recent and highest quality study available 1. First, thoroughly clean the wound with sterile saline or antiseptic solution to remove debris and contaminants. Control bleeding with gentle pressure. Carefully examine the nailbed for lacerations, which should be repaired using 6-0 or 7-0 absorbable sutures to restore anatomical alignment. If the avulsed nail is intact and clean, it can be replaced as a biological dressing after being sterilized in antiseptic solution; alternatively, use non-adherent gauze or silicone sheets as a substitute. Some key considerations in managing complete nail avulsion include:
- Applying antibiotic ointment such as bacitracin or mupirocin to prevent infection
- Covering with a bulky, protective dressing and considering finger splinting for comfort and protection
- Prescribing appropriate pain management with acetaminophen or NSAIDs, adding short-term opioids if necessary for severe pain
- Recommending prophylactic oral antibiotics (such as cephalexin 500mg four times daily for 5-7 days) if there's significant contamination or crush injury, as supported by studies like 2
- Updating tetanus prophylaxis if needed
- Scheduling follow-up within 48-72 hours to assess healing and change dressings The protective covering should remain in place for 2-3 weeks to guide nail regrowth, which typically takes 3-6 months. This approach preserves nailbed integrity, prevents adhesions, and optimizes cosmetic and functional outcomes as the new nail grows. Techniques such as partial nail plate avulsion, as discussed in 1, can be preferable to minimize trauma, but the specific approach may vary based on the individual case and the surgeon's expertise.