Ensure appropriate suture is available and reinforced silcone sheeting if nail is not salvageable
Nailbed Repair Technique
Sign operative site.
Pre-operative antibiotics.
1% plain lidocaine digital block.
Prep and drape
Finger tourniquet.
Nail removed with Kutz elevator or iris scissors.
Undersurface of nail cleared of any residual tissue and soaked in providie-iodine solution.
Examine nailbed under 2.5x loupe magnification.
Undermine edges @ 1mm.
Irrigate.
Repair with 7-0 chromic sutures, GS-9 opthalmic needle. Simple sutures.
Place hole in the previously removed nail for drainage and replace nail. If nail is not available use 0.020" reinforced silicone sheeting or nonadherent gauze.
Suture nail in place with 5-0 nylon suture placed in a horizontal mattress configuration through the nail fold.
Severely displaced distal phalanx fractures can be reduced and pinned with 0.028 K-wires.
