Nail Bed Repair RCT
Stanford University
Summary
This study compares the outcomes of fixing nail bed injuries with nail bed repair versus irrigation and dressing alone. The main question this study aims to answer is "Does nail bed repair after nail bed injury lead to better outcomes?"
Description
This study compares two treatment methods for patients with nail bed injuries. The first method is irrigation and dressing. The second method is nail bed repair. Patients will be randomized into one of the two groups and outcomes will be documented in both groups.
Eligibility
- Age range
- 2+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * patients 2+ years of age * presenting with disruption of nail plate or laceration adjacent to nail which appears that it may extend into the nail matrix OR subungual hematoma \>50% of nail * presenting within 3 days of acute injury Exclusion Criteria: * missing (e.g. avulsed) nail bed or segment of nail bed, * prior injury to affected nail * need for surgical treatment of injury (e.g. underlying operative fracture)
Interventions
- OtherNail Bed Repair
1. Block involved digit with 3cc 1% lidocaine injected subcutaneously over volar and dorsal metacarpophalangeal joint 2. Apply tourniquet to base of finger if desired 3. Remove nail using freer/hemostats 4. Irrigate wound with at least 500cc normal saline 5. Repair nail bed laceration with 5-0 chromic or monocryl suture 6. Stent eponychium with native nail or fashion substitute from foil suture packet and secure with 2 sutures 7. Dress finger with bacitracin, xeroform, and 2" kling wrap 8. Splint finger as needed with alumifoam splint (apply splint to volar side of finger so as to avoid pressure to nail bed) 9. Repair any other lacerations as needed
- OtherNail bed dressing
1. If there is a subungual hematoma \>50% of the nail, trephinate the nail plate using an 18G needle 2. Irrigate wound with at least 500cc normal saline 3. Dress finger with bacitracin, xeroform, and 2" kling wrap 4. Splint finger as needed with alumifoam splint (apply splint to volar side of finger so as to avoid pressure to nail bed) 5. Repair any other lacerations as needed
Location
- Stanford UniversityPalo Alto, California