Nail bed repair is an operation to reconstruct the tissue beneath the fingernail following a crush injury or laceration. It aims to restore normal nail growth and finger appearance.
The damaged fingernail is carefully removed (or lifted if still partially attached). The lacerated nail bed is repaired with fine absorbable stitches under magnification. Any fracture of the underlying bone (distal phalanx) is assessed and managed. The nail (or a substitute) is replaced to act as a splint for the repair and protect the nail fold. The procedure takes 30–60 minutes.
Nail bed repair is recommended for significant lacerations of the nail bed, subungual haematomas involving more than 50% of the nail, and displaced fractures of the distal phalanx with nail bed injury. Early repair gives the best chance of normal nail regrowth.
Small, undisplaced injuries with an intact nail may be managed conservatively. Subungual haematomas can sometimes be drained (trephined) without removing the nail.
This is usually performed as an urgent day-case procedure. X-ray to assess for an underlying fracture.
The aim is to restore normal nail growth. Meticulous repair gives the best chance, but some nail irregularity is common, particularly with severe injuries. The nail takes four to six months to grow back fully.
Some degree of nail ridging, splitting, or deformity is common despite repair.
The fingertip may be sensitive for several months.
Fingertip swelling.
The new nail may not fully adhere to the nail bed.
Wound or bone infection, particularly with open fractures.
In severe injuries, the nail may not regrow.
The nail may curve over the shortened fingertip if bone was lost.
Digital nerve block (ring block) or general anaesthesia.
A protective dressing and splint for the first two weeks. The replaced nail typically falls off after four to eight weeks as the new nail grows beneath it. Gentle finger movement is encouraged early. Full nail regrowth takes four to six months. The final nail appearance may take up to twelve months to become apparent.
Wound check at one to two weeks. Further review at six weeks.
Many patients achieve a cosmetically acceptable nail, but some irregularity is common. The final result depends on the severity of the original injury.
Fingernails grow approximately 1 mm per week. Full regrowth takes four to six months.