INRO Surgical Nail Splint Application

Method of Application
Anatomical repair of the nail bed is performed under sterile conditions using 6-0 vicryl. The nail splint is trimmed to size with scissors, with any excess being removed from the distal end and the sides.

A. While the injury site is still fresh, and before obliteration of the eponychium, the sterile splint is installed. Using 5-0 nylon, the needle is inserted at one side of the eponychium, in antegrade fashion.

The trimmed size of the splint should be about the size of the nail bed and the germinal matrix. The splint may be removed 4-6 weeks later, or when the nail bed has healed. If only a small amount of nail tissue is lost, there usually is no need for a nail bed graft, because spontaneous regeneration almost always occurs. The four perforations in the split allows for ready drainage of the hematoma.

B. The needle is guided through the nail fold using a curved hemostat, taking care to avoid violating the germinal matrix.	C. The needle is then passed through the proximal part of the nail splint in retrograde manner.	D. The needle is then traced retrograde through the nail fold to exit more proximal than the entry point, care being taken not to suture the germinal matrix. A hemostat in the nail fold is helpful.
E. The same process is then repeated on the other side of the eponychium.	F. Gentle traction applied to both ends of each suture will seat the nail splint firmly into the sulcus. Distal sutures are then applied at the corners, taking care not to displace the splint from the suclus.	G. The nylon sutures are then tied and trimmed. When necessary, additional sutures can be applied to the sides. An appropriate dressing is applied.