Suture Selection for Fingertip Laceration with Nail Involvement
For a fingertip laceration with slight nail involvement where the nail remains intact, 6-0 monofilament non-absorbable sutures are recommended for optimal wound closure and healing outcomes. 1
Suture Material Selection
- Monofilament sutures are preferred over multifilament (braided) sutures as they cause less bacterial seeding and may reduce infection risk in this delicate area 1, 2
- For fingertip lacerations with nail involvement, 5-0 or 6-0 monofilament non-absorbable sutures are recommended for optimal wound closure 1
- When the nail is intact but the nail bed is involved, careful repair is essential to prevent nail deformities while maintaining the protective function of the nail plate 3
- Absorbable sutures like poliglecaprone (MONOCRYL) can be considered as an alternative, particularly when suture removal might be difficult or painful 4
Suturing Technique
- For nail bed lacerations, a continuous non-locking suturing technique is recommended as it distributes tension more evenly across the suture line 1
- When the nail is still intact with slight involvement, care must be taken to avoid further damage to the nail bed during repair 3
- If the nail bed laceration is accessible without removing the nail plate, repair can be performed while preserving the nail in place 5
- For very small lacerations with minimal nail involvement, tissue adhesive (2-octylcyanoacrylate) can be considered as an alternative to suturing, as it provides similar cosmetic outcomes with significantly shorter procedure time 6, 7
Procedural Considerations
- Apply appropriate topical anesthesia such as LET (lidocaine, epinephrine, and tetracaine) to the wound before repair to minimize pain 1
- Allow the topical anesthetic to work for 10-20 minutes or until wound edges appear blanched before proceeding with repair 1
- For supplemental anesthesia, lidocaine can be injected using a small-gauge needle with slow injection technique to minimize pain 1
- Ensure proper wound cleaning and preparation before suturing to reduce infection risk 1
Post-Repair Care
- Keep the wound clean and dry for the first 24-48 hours 8
- Monitor for signs of infection such as increasing pain, redness, swelling, or discharge 8
- Pain management can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs 1
- Follow-up should be scheduled to ensure proper healing and to address any complications early 1
Special Considerations for Nail Bed Involvement
- If the nail bed laceration becomes more extensive during examination, the nail plate may need to be removed for proper repair 3
- Any free segments of nail bed should be preserved and sutured in place as a free graft if the nail plate needs to be removed 3
- In children, more conservative approaches may be appropriate as they have better healing potential 3, 6
- The cosmetic and functional outcomes of fingertip repairs are generally good with proper technique, regardless of whether sutures or tissue adhesives are used 7