Nail bed lacs in 2022
Our approach to nail bed lacerations has evolved quite a bit over the last decade or two. The old teaching was that a significant subungual hematoma required removal of the nail to check for a nail bed laceration, and if present, painstaking suturing of the laceration with fine friable absorbable suture. Then, the nail plate or a substitute such as the foil from the suture packet needed to be placed in the nail fold to stent it open. Current state-of-the-art is much simpler! Simply trephinate significant subungual hematomas (e.g. > 50%, raising the nail, painful). If a nail bed laceration is to be repaired, tissue adhesive is an easier acceptable alternative to suturing. And there may not be a need to stent the nail fold unless there is direct injury to the nail fold itself. Check out this review from the experts.