From the Guidelines
For a torn nail with an exposed nail bed, use an occlusive dressing such as petrolatum or hydrogel directly over the exposed area, as it results in better wound healing compared to dry dressings 1. When managing a torn nail with an exposed nail bed, it's crucial to prioritize wound healing and prevent infection.
- First, gently clean the area with mild soap and water or saline solution to remove any debris or bacteria.
- Apply a thin layer of a non-antibiotic, non-antimicrobial dressing, as there is no indication that antibiotic or antibacterial dressings improve wound healing or decrease infection rates in clean wounds 1.
- Cover with an occlusive dressing, such as petrolatum or hydrogel, to maintain a moist healing environment.
- Secure the dressing with a sterile gauze pad and paper tape or a bandage that won't stick to the wound.
- Change the dressing daily or whenever it becomes wet or soiled to promote optimal healing. It's essential to monitor for signs of infection, such as increasing pain, redness, swelling, warmth, or discharge, and seek medical attention if these symptoms occur. Additionally, consult a healthcare provider if the nail injury is severe, deeply torn, or if you have conditions like diabetes that may affect healing. The use of occlusive dressings, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1, prioritizes wound healing and minimizes the risk of infection, ultimately improving morbidity, mortality, and quality of life outcomes.
From the FDA Drug Label
Directions adults and children 2 years of age and older: clean the affected area apply a small amount of this product (an amount equal to the surface area of the tip of a finger) on the area 1 to 3 times daily may be covered with a sterile bandage The dressing to use over a torn nail with exposed nail bed is a sterile bandage 2.
From the Research
Dressing Options for Torn Nail with Exposed Nail Bed
- The use of a temporary metal foil stent after primary repair of acute nail bed injuries is a simple and dependable method for restoration of the smooth nail bed, as it prevents adherence of the proximal nail fold to the underlying matrix, promoting patient comfort during subsequent dressing changes 3.
- Nail bed lacerations may be repaired using dissolvable suture or octyl-2-cyanoacrylate, and in most cases with no need to replace the nail plate or stent the fold 4.
- For subungual hematomas, simple trephination may be used for pain relief, and no specific dressing is mentioned 4.
- In general, the management of nail bed and fingertip injuries requires careful evaluation and treatment to avoid chronic pain and deformity, and the choice of dressing may depend on the specific injury and treatment approach 5, 6, 4.
Key Considerations
- The goal of treatment is to restore the smooth nail bed and prevent complications such as chronic pain, deformity, and aesthetic sequelae 5, 6, 4.
- The choice of dressing and treatment approach may depend on the extent and severity of the injury, as well as the patient's overall health and medical history 5, 6, 4.