Downloaded 161 times
Uploaded byVaikunthan Rajaratnam
Nail bed injuries
The document discusses nail bed injuries, outlining anatomy, function, and repair techniques. It highlights various types of injuries, their treatments, and emphasizes the importance of careful inspection and management of associated structures. Additionally, it covers advanced repair strategies for complex lacerations and avulsions, addressing complications like nail deformities and loss of nail functionality.
More Related Content
Similar to Nail bed injuries
Nail bed injuries
- 1.
- 2. Learning outcomes • Understandthe relationship between anatomy , functions and injuries of the nail bed • Develop repair and reconstruction techniques for the injuries and their complications
- 3. Nail bed lacerations •Remove nail and inspect nail bed • Nail fold may be elevated using back cuts at the corners • Simple laceration – 7/0 chromic sutures • Repair under magnification • Limit debridement – avoids tension on repair and prevent scarring • Replace nail plate or cover with artificial sheet – protects and moulds nail bed
- 6. Anatomy of thenail complex Macroanatomy
- 7. Production of thenail • Onchyn – keratinous material produced by the death of the germinal cells • Nail growth slows after the age of 30 years • Produced in 3 areas • Germinal matrix – 90% • Sterile matrix – adherence • Dorsal roof – nail shine
- 8. Nail vascular supply •From volar digital arteries • Large branch to the pulp • Branch to the paronychium • Branch to the proximal nail fold • Multiple small branches into the nail bed • Radial vessels are larger on the ring and small finger. • Venous return is in a random fashion over dorsum
- 9. Types of NailInjuries • Crush injuries • Sharp laceratons • likely to result in tip amputations • Avulsion • Iatrogenic • Inadequate phalangeal reduction • Placement of fixation pins • Nail biting/ flicking of the eponychium
- 10. Basic principles • Injuriesmay involve several anatomic structures • Loss of germinal matrix results in no hard nail growing • Loss of sterile matrix results in non-adherence • Radiographs to evaluate assoc. fractures
- 11. Paronychial injuries • Simplelacerations – repaired primarily • Loss of part of the paronychium • VY advancement • Cross-finger flap • Thenar flap • Dorsal roof laceration • Primary suture • Loss of tissue – grafting needed
- 12. Associated DP fractures •50% of nail bed injuries • Comminuted tuft fractures • Can be stabilised by the avulsed nail with figure of eight suture • Proximal DP # result in nail deformities • Adequate reduction with crossed K- wires • Salter I of the DP can present as avulsed nail sitting on the eponychium – accurate reduction needed
- 14. Subungual Haematoma • Ifnail plate still adherent – trephinization • Using cautery • Heated paper clip • Needle • Nail bed injuries may be missed • Partially avulsed nail plate • Remove and inspect • Leave in place
- 16. Complex lacerations • Accuratedetermination of the damaged tissues • Replace like with like • Complex stellate lacerations • Meticulous re-apposition • Inspect under surface of nail plate
- 17. Avulsions • Look underavulsed nail • In small avulsions replace nail • Loss of sterile matrix • Graft from adjacent sterile matrix • Loss of >50%- graft from toe/adjacent finger
- 18. Loss of germinalmatrix • Graft of 1cm can take • Delayed to determine viability of nail • Composite graft from toe/finger • Acutely – less scar tissue and better blood supply but more risk of infection
- 19. Partial amputations • Ablatenail bed completely • Cover the tip • Shorten the nail bed • Hook nail - Unsightly and interferes with function • Loss of nail bed but reasonable bony support – combination of local flap and nail bed graft
- 20. Eponychial loss • Aftertrauma and tumour resection • Any excision should be replaced with a composite graft • Reconstructing the dorsal roof of the nail • split-thickness sterile matrix graft on the deep surface of the local flap
- 21. Onycholysis • Non-adherence • Caused •Trauma • Irritation • Dissolving of hyponychial plug • Age • Onychomychosis • Scarring in the sterile matrix • Narrow – excised and primary sutured • Wide - grafted
- 22. Split nails • Longitudinalscar • Removal of nail • Narrow, diagonal or transverse – excision and suturing • Longitudinal – multiple z-plasties • Wide • Split thickness sterile matrix graft • Full thickness germinal matrix graft • Split thickness graft of germinal matrix do not produce nail • Horizontal scar – double nail
- 23. Bone irregularities • Osteophytes •Post traumatic inclusion cysts of sterile matrix • Deformity of nail and erosion of bone • Curettage of cysts • Enchondromas • Curettage and bone graft • Fish-mouth incision
- 24. Nail absence • Congenitalor traumatic • Skin graft • Artificial nail • Microvascular transfer • Non-vascularised composite graft • less reliable • better results in children
- 25. Tech Hand UpExtrem Surg. 2005 Mar;9(1):42-6. The aesthetic mini wrap-around technique for thumb reconstruction. Adani R1, Marcoccio I, Tarallo L, Fregni U.
- 26. Pincer nail • Thumband great toe • Pain • Trauma, tight shoes, hereditary • Nail bed becomes neuro- vascularly compromised • Nail removal • Excision of paronychium • Freeing paronychium from periosteum
- 27. Hooked nail • Growingnail follows nail matrix • Tight closure of finger tip amputation • Loss of bony support • Absent distal phalanx • Trim nail bed • Replace bone • Shorten nail • Release pulled over nail bed – V-Y • Bone graft
- 29. Antenna procedure J HandSurg Am. 1983 Jan;8(1):55-8. The "antenna" procedure for the "hook-nail" deformity. Atasoy E, Godfrey A, Kalisman M.
- 31. Br J PlastSurg. 1992 Nov-Dec;45(8):591-4. Trimmed second toetip transfer for reconstruction of claw nail deformity of the fingers. Koshima I1, Moriguchi T, Umeda N, Yamada A.
- 32.