NAIL BED INJURIES

Question 1

3 main types of nail bed injuries

Answer 1

1. Subungual haematoma
2. Nail bed laceration
3. Nail bed avulsion

Question 2

Anatomy of nail bed

Answer 2

1. Perionychium
   - nail plate
   - nail bed
   - surrounding skin
2. Eponychium = proximal nail fold
3. Paronychium = lateral nail folds
4. Sterile matrix
   - under nail plate
   - adheres to nail plate
5. Germinal matrix
   - under eponychium
   - responsible for nail development
   - insertion of extensor tendon is 1.2-1.4mm proximal to germinal matrix

Question 3

Management of subungual haematomas

Answer 3

1. If < 50% of nail involved = percutaneous drainage

2. If > 50% of nail involved = nail plate removal and nail bed repair

Question 4

Management of nail bed lacerations and avulsions

Answer 4

Nail plate removal
Nail bed repair = 6.0 or smaller absorbable suture (vicryl rapide)
Spacer under eponychium to allow nail growth

Question 5

RCT comparing nail bed repair with suture vs. Dermabond

Answer 5

Nail bed repair with Dermabond faster

Similar cosmetic and functional outcomes