What is the management for a nail cut from the middle by a saw?

Management of Nail Cut from the Middle by a Saw

The management of a nail cut from the middle by a saw should include thorough cleaning, removal of the nail if necessary, repair of the nail bed, and appropriate wound care to prevent infection and promote proper healing. 1, 2

Initial Assessment and Management

• Thoroughly clean the wound with antiseptic solutions such as povidone-iodine or dilute vinegar soaks (50:50 dilution) to remove debris and prevent infection 3
• Assess the extent of injury to determine if the nail bed is damaged beneath the nail plate 2
• If the nail is partially avulsed or severely damaged, complete removal may be necessary to properly evaluate and repair the underlying nail bed 1, 2
• When removing the nail, use gentle technique to minimize additional trauma to the nail bed 2
• Examine for associated fractures of the distal phalanx, which commonly occur with nail injuries from saws or other mechanical trauma 2, 4

Nail Bed Repair

• If the nail bed is lacerated or damaged, meticulous repair is essential to prevent long-term nail deformities 2, 4
• Use fine absorbable sutures (6-0 or 7-0) to repair the nail bed, ensuring precise alignment of the edges 4
• For complex nail bed injuries with tissue loss, consider a nail bed graft from another digit if necessary 4
• After repair, the original nail (if intact) or a substitute (such as sterile foil or silicone sheet) should be placed back under the proximal nail fold to prevent adhesions and maintain the nail fold space 1, 4

Wound Care and Infection Prevention

• Apply topical antibiotics to prevent infection, particularly important in saw injuries which can introduce contaminants 5, 6
• Consider oral antibiotics if there is significant contamination, delayed presentation (>24 hours), or signs of infection 5
• Most nail gun or saw injuries require a short course of antibiotics as infections are relatively rare but can occur, especially with delayed presentation 5
• Regular antiseptic soaks with dilute vinegar or 2% povidone-iodine for 10-15 minutes twice daily during the healing period 3

Follow-up Care

• Keep the wound clean and dry, changing dressings regularly 3
• Monitor for signs of infection including increased pain, redness, swelling, or purulent drainage 3
• Reassess wound healing at 2 weeks post-procedure to determine if additional interventions are needed 3
• Be aware that nail regrowth may take 3-6 months, and the new nail may initially have irregularities 4

Prevention of Complications

• Proper immobilization of the digit may be necessary to protect the repair and promote healing 4
• Avoid activities that could cause additional trauma to the healing nail for at least 2-4 weeks 3
• Be vigilant for signs of nail deformities during regrowth, which may indicate inadequate initial repair 2, 4
• For persistent pain or drainage beyond 2-4 weeks, consider surgical re-evaluation 3

Special Considerations

• If granulation tissue forms during healing, options include scoop shave removal with hyfrecation or silver nitrate application 1, 3
• For recurrent or treatment-refractory cases with significant inflammation, consider intralesional triamcinolone acetonide 1
• Be aware that secondary bacterial or mycological superinfections can occur in up to 25% of cases and may require specific antimicrobial therapy 7