Why Aluminum Foil is Used After Nail Bed Repair
Sterile aluminum foil (or similar material) serves as a protective nail plate substitute that prevents adhesions between the proximal nail fold and nail bed while protecting the healing tissue until the new nail grows.
Primary Functions of the Nail Plate Substitute
The nail plate substitute serves multiple critical protective roles:
- Prevents adhesions between the proximal nail fold and the underlying nail bed, which would otherwise cause permanent nail deformity 1
- Protects the tender, healing nail bed from painful mechanical stimuli during the healing process 1
- Maintains the anatomical space of the nail fold to allow proper growth of the new nail 1
- Allows drainage through a small central hole that prevents hematoma accumulation 1
Material Properties and Application
Aluminum foil (or polypropylene alternatives) is specifically chosen because:
- It is sterile, inexpensive, and readily available in operating theaters 1
- The material is flexible enough to conform to the natural curvature of the nail bed 1
- It can be trimmed to reproduce the profile of the avulsed fingernail, with the proximal edge thinned to ease insertion into the nail fold 1
- A small drainage hole is created in the center to allow blood and fluid drainage 1
Duration and Removal
- The substitute is typically removed one month after application, by which time the new nail has begun growing 1
- This timing allows adequate protection during the critical healing period while preventing chronic complications 1
Alternative When Original Nail is Available
When the original nail plate is intact and clean:
- Some surgeons replace the original nail plate after cleaning and disinfecting it, though this practice is debated due to potential infection risk 2, 3
- The original nail can be secured with sutures or tissue adhesive (n-butyl-2-cyanoacrylate) 4
Critical Pitfall to Avoid
Failing to use any nail plate substitute leads to adhesions between the nail fold and nail bed, resulting in permanent nail dystrophy and poor cosmetic outcomes 1. The substitute must remain in place for the full healing period to prevent this complication.