Treatment of Finger Laceration Through Nail
The standard treatment for nail bed lacerations involves nail removal, meticulous cleaning and repair of the nail bed, followed by appropriate management of any associated complications such as infection or hematoma. 1
Initial Assessment and Management
- The nail should be carefully removed to expose the nail bed laceration, allowing for proper visualization and repair of the underlying injury 1
- Thorough cleaning of the wound is essential, with irrigation using potable tap water being as effective as sterile saline for wound cleaning without increasing infection risk 2, 3, 4
- Bacterial cultures should be obtained if infection is suspected 1
- Local anesthesia should be administered for pain control, with buffered lidocaine being an effective option for almost painless injection 5
Repair Technique
- After nail removal and cleaning, the nail bed laceration should be meticulously repaired 1
- For simple lacerations, tissue adhesives or wound adhesive strips can be effective in low-tension skin areas 2
- The nail bed must be thoroughly cleaned during the procedure to prevent infection and promote proper healing 1
- Wounds heal faster in a moist environment, so occlusive or semi-occlusive dressings should be considered 2
Infection Prevention and Management
- If pus is present, obtain cultures and initiate appropriate antibiotics with coverage against Staphylococcus aureus and other gram-positive organisms 1
- Daily dilute vinegar soaks (50:50 dilution) to the nail folds twice daily can help reduce inflammation 5, 1
- For edema and pain, mid to high potency topical steroid ointment can be applied to nail folds twice daily 5, 1
- Tetanus prophylaxis should be provided if indicated based on immunization history 2
Post-Repair Management
- Regular nail trimming is necessary until the nail plate grows reattached 1
- For children, topical anesthetics such as LET (lidocaine, epinephrine, and tetracaine) can be applied to open wounds prior to repair to minimize pain 5
- Early mobilization of the finger should be encouraged to prevent stiffness, as long as it doesn't compromise the repair 6
Complications to Monitor
- Watch for signs of infection including increased pain, redness, swelling, or purulent drainage 1, 7
- Be alert for herpetic whitlow, which can mimic a bacterial abscess but requires non-operative treatment 7
- Chronic onycholysis and persistent subungual hyperkeratosis can develop if the nail is not properly removed when indicated 1
Special Considerations
- Artificial nails and nail polish can harbor microorganisms and potentially increase infection risk 7
- Trauma (mechanical or chemical) is usually the trigger enabling infiltration of infectious organisms 7
- The timing of repair is flexible, as studies have been unable to define a strict "golden period" for wound closure without increasing infection risk 2