Nail Bed Laceration, Complex

Nail lacerationsare cuts or breaks in the nail, nail bed, or the surrounding areas. Complex lacerations may involve loss of part or all of the nail or nail bed. Nail bed lacerations may also result in a painful collection of blood under the nail (hematoma).

CAUSES

Nail bed lacerations are commonly caused by:

  • Crush injuries between large objects.

  • A sharp cut to the fingertip or toe.

  • Tearing injuries (avulsions) to the tips of the fingers or toes.

DIAGNOSIS

To relieve pain and help your caregiver see how bad the injury is, medicine to numb the area (local anesthetic) may be used. The caregiver may apply a compression bandage (tourniquet). A tourniquet helps to reduce the bleeding from the wound and makes it easier to examine the injury. X-rays may be done to see if there are broken bones as well.

TREATMENT

The exact treatment will depend on the details of the injury. Your caregiver may:

  • Straighten any broken bones if needed. This helps the chances of growing back a good nail.

  • Repair, realign, and close the wound in the nail bed with stitches that dissolve on their own (absorbable sutures).

  • Re-insert the nail (if intact) after repairing the nail bed. The nail is sometimes held in place with stitches. Sometimes, a small hole is made in the nail to allow for normal drainage of fluid or blood.

  • Put a small piece of silicone or special gauze over the nail bed if the nail is lost.

  • Recommend pain relievers or medicine to treat an infection (antibiotics).

Your caregiver may dress the wound with not sticky (non-adherent) material and antibiotic/antiseptic ointment. The wound may be dressed in a bulky wrap. A finger cap splint may be used for increased protection.

HOME CARE INSTRUCTIONS

  • If the fingernail was preserved, you may be asked to not change the bandage (dressing) for 5 to 7 days, unless there is oozing from the site. Your caregiver will give you specific instructions.

  • If the nail was lost, the first dressing may need to be changed within 12 to 24 hours. This may help prevent unwanted "sticking" of the dressing to the nail bed.

  • Keep your hand or foot raised (elevated) above the level of the heart when possible.

  • Gently clean the wound with soap and water before putting on a new dressing.

  • Apply antibiotic ointment when changing the dressing, if advised by your caregiver.

  • Move your hand or foot normally to prevent stiffness. Your caregiver may give you specific instructions.

  • Only take over-the-counter or prescription medicines for pain, fever, or discomfort as directed by your caregiver.

  • Do not smoke. This may affect the healing process.

You may need a tetanus shot if:

  • You cannot remember when you had your last tetanus shot.

  • You have never had a tetanus shot.

  • The injury broke your skin.

If you had a tetanus shot, the shot site may swell, get red, and feel warm to the touch. If you need a tetanus shot and you choose not to have one, you may get tetanus. Sickness from tetanus can be serious.

SEEK MEDICAL CARE IF:

  • You notice oozing or discharge from the injured site.

  • Your pain is not relieved even with prescribed medicines.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You develop severe bleeding.

  • The skin around the injury is turning dark blue or black.