Duration of Nail Fold Stenting After Fingernail Avulsion
The nail fold should be stented for approximately one month (4 weeks) after fingernail avulsion to prevent adhesions between the proximal nail fold and nail bed while protecting the healing tissue. 1
Rationale for Stenting Duration
The primary goal of stenting is to maintain the nail fold space and prevent adherences along the proximal nail bed until the new nail begins to grow. 1
The substitute serves dual purposes: preventing scarring between the nail fold and nail bed, and protecting the tender healing nail bed from painful stimuli during the recovery period. 1
In clinical practice with polypropylene nail substitutes, the device is typically removed one month after application, which corresponds to the critical healing period before new nail growth begins. 1
Technical Considerations for Stenting
The stent material (whether the original cleaned nail, silicone, or polypropylene) should be trimmed to reproduce the profile of the avulsed fingernail and thinned at the proximal edge to ease insertion into the nail fold. 1
A small drainage hole should be created in the center of the stent to allow blood and fluid drainage during the healing process. 1
The stent must remain in place long enough to protect the nail bed during the entire healing period until new fingernail growth commences. 1
Clinical Outcomes and Complications
When stenting is maintained for the appropriate duration (one month), patients report good protection of the fingertip during healing, and the new fingernail demonstrates good cosmetic appearance in most cases. 1
Poorer outcomes occur with injuries involving both the nail bed and nail fold, particularly when complicated by infection, making proper stenting duration even more critical in these cases. 2
Ninety percent of properly repaired nail beds achieve good to excellent results when appropriate protective measures, including adequate stenting duration, are employed. 2
Common Pitfalls to Avoid
Removing the stent too early (before 3-4 weeks) risks adhesion formation between the proximal nail fold and nail bed, which can result in permanent nail deformity.
Failing to create a drainage hole in the stent can lead to hematoma accumulation and increased infection risk.
Not thinning the proximal edge of the stent makes insertion difficult and can cause additional trauma to already injured tissues.