Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Basic wound care is the same for all nail injuries, although the specific repair techniques will vary depending on the type of injury. The wound will be cleaned so that the doctor can examine it more closely. A tetanus shot will be given if it has been longer than
five years since your last one.
If a repair is needed, the finger or toe will be numbed up prior to starting work. This is usually done by injecting medicine at the bottom of the finger or toe. This makes the entire finger or toe numb, so that you do not feel the doctor working on the nail.
Depending on the injury, the doctor may choose to inject the numbing medicine
directly into the nail bed or nail folds instead of numbing the entire finger.
Sometimes a tourniquet to slow the blood flow is used on the finger or toe during the repair. This helps prevent bleeding during the procedure, so that the doctor can see the wound more clearly.
Antibiotics are usually not given unless the bone is broken and there is bleeding or a laceration, or
if the wound is from a bite.
Nail bruise: The doctor may decide to drain the blood by placing a hole in the nail. This
painless procedure allows the blood to drain out of the hole and relieve the pressure and throbbing sensation. This can be done with a heated paperclip, a heated needle, or a battery-operated heating device. The doctor may
occasionally choose to remove the nail and examine the nail bed for a laceration. This is more likely if it is a large bruise and the bone is broken.
Nail laceration (cut): At least a portion of the nail will have to be removed prior to repair of the cut. The nail bed and the surrounding skin will have to be sewn up, often with several different types of sutures (stitches). After the nail bed has been repaired, the nail will be replaced and sewn or glued (with medical-grade glue) to the finger, or a special type of gauze will be inserted in place of the nail. This dressing will have to remain in place for
two to three weeks.
Fingertip amputation: The doctor will probably not be able to reattach the tip of the finger. If the piece is large and clean enough, a few major medical centers may
try to reattach the tip or improve the final appearance of the finger using
advanced techniques. Even with highly trained hand surgeons and microvascular
techniques, there is a high rate of failure with this procedure.
Nail avulsion: The nail sometimes can be replaced under the skin if there has been no damage to the nail bed. However, the nail bed has usually been injured and will have to be repaired.
Broken bone: If the bone is still in line, the doctor will repair any other injuries. A splint will then be placed on the broken finger or the broken toe to keep the bone in place. If the bone is out of line, a bone or hand specialist may have to place a wire in the tip of the finger to keep the bone in place. Antibiotics may be given if there is a laceration involved.