Pediatric Nailbed Repair Study

• DOI: 10.1097/prs.0b013e31823af1bb
• Publication Date: 2012-01-28T06:58:16Z
• Authors: Benjamin H. Miranda; Ismail Vokshi; Catherine J. Milroy
• Keywords: Vicryl

Sir:FigureFingertip injuries represent approximately two-thirds of pediatric hand injuries, with nailbed quoted to 15 24 percent cases.1 Although a variety methodologies exist, repair is usually undertaken fine absorbable sutures, nail replacement between the eponychial fold, and suture fixation.2 Nail or foil placement carries theoretically higher morbidity risk (e.g., infection) that may require general anesthetic surgical intervention. We therefore investigated complications in plastic surgery patients, younger than 16 years, 6-0 Vicryl Rapide (Ethicon, Inc., Somerville, N.J.) repairs (replacement group) versus where was discarded (discarded Mepitel dressing (Mölnlycke Health Care, Göteborg, Sweden) applied. A retrospective study (July 2009 June 2010) on referred following trauma. Outpatient attendance follow-up periods after were analyzed as indicators. Criteria defined for two types: delayed healing (not healed within 2 weeks repair) infection (two more following: cellulitis, pus, malodor3). Statistics using SPSS (SPSS, Chicago, Ill.). One hundred eleven 136 referrals fully traced (60 male patients 51 female patients; age, 5 ± 0.5 years), 12 sets notes untraceable 13 lost excluded because parents overruling decision operate. Overall (10.8 percent) occurred frequently nail-replacement group (17.6 nail-discarded (5 (p < 0.001) (Fig. 1). included wound (7.2 percent), (3.6 persistent pain (2.7 overgranulation (1.8 1).Fig. 1: complication rates significantly nail-replacement/foil-placement compared group, nine three 60 0.001). Delayed [six (11.7 (3.3 percent); p = 0.004] [four (7.8 zero (0 0.0001] also group.There outpatient visits (3 0.2 1.9 0.1; 0.01) longer period required (8.4 1 5.8 0.8 weeks; 0.03) (Table There greater percentages 3.3 percent; 0.004) 0 0.0001) one which intervention (Figs. 2). no differences (3.9 1.7 0.1) (2 0.2) 1).Table Nail-Replacement/Foil-Placement Pediatric Nailbed Repair*Fig. 2: Left index finger paronychia felon development, requiring intervention, an 8-year-old girl at 9 days tension band fixation (Bindra RR. Management nail-bed fracture-lacerations tension-band suture. J Hand Surg Am. 1996;21:1111–1113).These low keeping recently published data.4 have now shown causes increased morbidity, including infection. This most likely small nails are harder sterilize intraoperatively that, colonized wounds, “traps” microorganisms, increasing their potential infect underlying tissues. Such further surgery, exposing (and parents) psychological trauma risks anesthesia. Furthermore, increases number clinic periods, both inconvenient parents, resulting unnecessarily “clogging” busy clinics. Because previous studies cosmetic benefit replacement,5 should not be replaced refashioned from other material during repair. Benjamin H. Miranda, M.R.C.S.(Eng.), Ph.D. Ismail Vokshi, B.Sc. Catherine J. Milroy, F.R.C.S.(Plast.) Paediatric Plastic Surgery Unit, St George's Hospital, London, United Kingdom DISCLOSURE The authors financial interest declare relation content this article.