From the Research
For suturing through the nail, I recommend using 4-0 or 5-0 non-absorbable monofilament suture material such as nylon or polypropylene. These materials are ideal because they cause minimal tissue reaction, maintain tensile strength throughout the healing process, and are easy to remove once healing is complete 1. When performing this procedure, first ensure adequate anesthesia through a digital block. Clean the nail and surrounding tissue thoroughly, then use a small gauge needle to create pilot holes through the nail plate before passing the suture to prevent nail splitting. The suture should be placed with minimal tension to avoid nail deformity or pain. Typically, these sutures should remain in place for 7-10 days before removal. Non-absorbable sutures are preferred over absorbable ones because they need to be removed after healing, and leaving absorbable material under the nail could lead to foreign body reactions or infection 2. The monofilament structure also reduces the risk of bacterial wicking compared to braided sutures.
Some key points to consider when choosing a suture material for nail suturing include:
- The material's biocompatibility and potential for causing tissue reaction
- The material's tensile strength and ability to maintain its integrity throughout the healing process
- The ease of removal of the suture material once healing is complete
- The risk of infection and foreign body reactions associated with the suture material
It's also worth noting that antimicrobial-coated sutures have been shown to reduce the risk of surgical site infection, although the quality of the evidence is moderate to low 3. However, in the context of nail suturing, the use of non-absorbable monofilament suture material such as nylon or polypropylene is still recommended due to its minimal tissue reaction, ease of removal, and reduced risk of bacterial wicking.
In terms of specific suture materials, polybutester suture and expanded polytetrafluoroethylene (ePTFE) suture have been developed with unique properties, such as enhanced biomechanical performance and reduced risk of infection 4. However, these materials may not be necessary for routine nail suturing, and the use of non-absorbable monofilament suture material such as nylon or polypropylene is still recommended.
Overall, the choice of suture material for nail suturing should prioritize the patient's safety, comfort, and outcome, and non-absorbable monofilament suture material such as nylon or polypropylene is the recommended choice.