How long until sutures should be removed after a traumatic finger nail avulsion where the nail is tacked on with sutures?

Timing of Suture Removal After Traumatic Fingernail Avulsion with Nail Tacking

Sutures used to tack on an avulsed fingernail should typically be removed after 7-10 days to prevent complications while ensuring adequate healing.

General Principles for Nail Avulsion Suture Removal

• Suture removal timing for nail avulsions follows similar principles to other surgical wounds, with non-absorbable sutures typically removed 7-9 days after surgery 1
• Leaving sutures in place too long increases risk of infection, while removing them too early may result in wound dehiscence and widened scars 1
• The nail plate serves as a protective splint for the nail bed during healing, and maintaining this protection for an appropriate duration is essential 2

Factors Affecting Timing of Suture Removal

• Location factors: Fingers have good blood supply which promotes faster healing compared to other body areas 1
• Patient factors: Age, comorbidities (especially those affecting wound healing like diabetes), and immunosuppression may necessitate adjustments to standard timing 1
• Wound characteristics: The extent of the avulsion and whether the nail bed required repair influence optimal suture removal timing 2, 3

Specific Recommendations for Fingernail Avulsion

• Standard timing: Remove sutures tacking the nail plate 7-10 days after placement 1
• Assessment before removal: Ensure the nail bed has begun healing and the nail plate is stable enough to remain in place without sutures 2
• Protective function: The tacked-on nail serves to:
  • Protect the tender nail bed from painful stimuli during healing 2
  • Prevent adherences between the proximal nail bed and nail fold 2
  • Guide the growth of the new nail plate 3

Special Considerations

• If the patient reports significant pain or signs of infection develop (increasing redness, swelling, purulent drainage), earlier suture removal may be warranted 1
• For complex nail bed injuries with repairs, slightly longer suture retention (up to 14 days) may be considered to ensure adequate healing 3, 4
• After suture removal, the tacked-on nail should generally remain in place until it naturally separates as the new nail grows in 2

Potential Complications

• Early removal complications:

  • Premature displacement of the nail plate 2
  • Increased risk of nail bed adhesions 2, 3
  • Potential for nail bed exposure and pain 2

• Delayed removal complications:

  • Increased risk of infection 1
  • Suture track marks or scarring 1
  • Inflammatory reaction to suture material 1

Post-Suture Removal Care

• After suture removal, the tacked-on nail should remain in place until the new nail grows in sufficiently 2
• The nail substitute typically remains for approximately one month total after the initial procedure 2
• Patients should be advised to keep the area clean and dry, and to avoid activities that could dislodge the nail plate 2