Dermatology Book

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Nail Bed Laceration

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  1. See Also
    1. Fingernail
    2. Nail Abnormality
  2. Causes: High force crush or Laceration injury
    1. Machine press
    2. Rotary saw
  3. Associated conditions
    1. Large Subungual Hematomas (>50% of nail)
    2. Distal Tuft Fracture
  4. Radiology: AP, lateral and Oblique XRay of digit
    1. Assess for distal Tuft Fracture
  5. Management: Repair
    1. Anesthesia: Digital Nerve Block
    2. Apply tourniquet at digit base
      1. Clamp 1/4 inch Penrose drain at base of finger
    3. Nail Removal in normal fashion
    4. Suture nail bed Laceration
      1. Use 6-0 or 7-0 Absorbable Suture
    5. Bandage nail bed (to be left in place 2-3 weeks)
      1. Consider cleaning and re-applying nail or
      2. Apply petroleum gauze over exposed nail
  6. Indications for Orthopedic Consultation
    1. Distal tip amputation (risk of hook nail)
  7. References
    1. Brandenburg (1996) Consultant p.331-340
    2. Calmbach (1996) Lecture in Minneapolis
    3. Dvorak (1996) Lecture in Minneapolis
    4. Lillegard (1996) Lecture in Minneapolis
    5. Wang (2001) Am Fam Physician 63(10):1961

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