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Nail bed injury repair
This surgery repairs a cut or crushed nail bed, giving the fingernail the best chance of growing back looking and feeling normal.
At a glance
Anaesthetic
Can be done under local anaesthetic in adults, or sedation if you prefer; general anaesthetic in children.
Where
The Avenue Hospital
Day case or overnight
Day case - home the same day
First post operative review
Approximately one week after surgery
Driving
Usually fine once comfortable, unless a splint limits your grip
Post Operative Hand Therapy
Not usually required for an isolated nail bed repair
Splinting
A protective dressing or splint is worn for around 1 to 2 weeks while the nail bed heals
Pain relief
Usually simple pain relief such as paracetamol and/or ibuprofen
Return to repetitive & heavy loading
Usually 1 to 2 weeks, longer if there is an associated fingertip fracture
Repair of the nail bed after a fingertip injury
The fingernail is removed or lifted to expose the nail bed underneath. Any laceration is repaired with fine dissolving sutures, and the nail — or a substitute, such as the sterile packaging from the suture material — is replaced under the nail fold to keep it open while a new nail regrows over the following months.
Who is this procedure for?
- A nail bed laceration, especially one associated with a fracture of the distal phalanx or a nail that is torn or partially avulsed
- A large, tense and painful subungual haematoma
- Not usually needed for a small, non-tender subungual haematoma without a nail or nail bed injury, which can be managed by drainage alone or observation
What does the surgery involve?
Under local anaesthetic (with or without sedation), the nail is removed or lifted to inspect the nail bed. Any laceration is repaired with fine dissolving sutures under magnification. An associated distal phalanx fracture is checked and treated if needed. The nail, or a substitute, is replaced to protect the healing nail bed and keep the nail fold open, and a dressing is applied.
Alternatives to surgery
Surgery is one option after a nail bed injury. Depending on your situation, the alternatives may include:
- Drainage alone: a small, non-tender haematoma without a significant nail bed laceration can sometimes be managed by draining the blood through a small hole in the nail (trephination) alone
- Whether repair is needed: depends on the size of the haematoma and whether the nail and nail bed are intact
What happens if left untreated: an unrepaired nail bed laceration can heal with scarring that causes the new nail to grow back split, ridged or deformed.
Dr Tomlinson will discuss which option suits your specific injury at your consultation.
Frequently Asked Questions
Where will my surgery be done?
At The Avenue Hospital.
How much time will I need to have away from work?
This depends on what your job involves. Most people return to desk-based work within a few days to a week. Manual or repetitive hand work usually needs a little longer while the fingertip settles.
When will I be able to drive again?
Usually once you are comfortable and your dressing or splint does not limit your grip on the steering wheel.
When can I do a full day of administrative or desk work?
Often within a few days, provided the dressing does not interfere with typing or other tasks.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include a protective finger cover, or reassigning tasks that need repeated use of the injured finger.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during a general anaesthetic. In line with current ANZCA guidance, if you’re having sedation or a general anaesthetic you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication — your anaesthetist will give you specific instructions.
How long will I need to wear a splint or dressing?
A protective dressing or splint is usually worn for around 1 to 2 weeks while the nail bed heals, longer if there is an associated fingertip fracture.
Will I need to see a hand therapist afterwards?
Not usually for an isolated nail bed repair, though your surgeon may refer you if there is a significant associated fracture or stiffness.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and/or ibuprofen – is enough.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain — usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of this surgery
- Permanent nail deformity — ridging, splitting or a nail that does not reattach normally — despite a well-performed repair, as this depends partly on the severity of the original injury
- Loss of the nail, which is usually temporary while a new nail grows over the following 4 to 6 months
- If there is an associated fracture, the usual risks of fracture healing
Anaesthetic
If you are having a general anaesthetic or sedation, your anaesthetist will discuss the specific risks with you beforehand. Local anaesthetic carries a small risk of an allergic reaction, bruising, or the anaesthetic not fully numbing the area, which can be managed on the day.
Recovery & rehabilitation
First 48 hours
Keep the dressing dry and intact. Elevate your hand if it is swollen
First week
Keep the dressing intact as directed and protect the fingertip from knocks
Second week
The dressing or splint continues to protect the nail bed as it heals
6 weeks
The nail bed is usually fully healed, and the new nail is beginning to grow forward beneath any remaining old nail
3 months
The new nail continues to grow forward, though it is not yet fully grown out
Long term
A full new nail typically takes 4 to 6 months to grow out completely, and its final appearance can take up to a year to settle
Want to know more about nail bed injury repair?
Contact us to schedule an appointment with Dr Tomlinson.
Fees and costs
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.