Skip to main content

Injuries to the Nail Apparatus

  • Chapter
  • First Online:
Fingertip Injuries

Abstract

The fingernail serves many functions during everyday use of the hand that are often taken for granted. The perionychium is a multifaceted structure, the anatomic details and physiologic function complexities of which must be firmly grasped by those surgeons wishing to effectively treat injuries to the fingertip. The nail itself serves to protect the fingertip, regulate peripheral circulation, and enhance the tactile sensibilities that allow humans to perform very fine motor functions. Injuries to the nail apparatus cause functional deficits and cosmetic deformities. Because of the relative prominence of the nail on the fingertip, the perionychium is the most frequently injured part of the hand.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

 References

  1. Lewis BL. Microscopic studies of fetal and mature nail and surrounding soft tissue. AMA Arch Dermatol. 1954;70:732–47.

    Article  Google Scholar 

  2. Barron JN. The structure and function of the skin of the hand. Hand. 1970;2:93–6.

    Article  CAS  PubMed  Google Scholar 

  3. DeBerker D, Mawhinney B, Sviland L. Quantification of regional matrix nail production. Br J Dermatol. 1996;134:1083–6.

    Article  CAS  Google Scholar 

  4. Johnson M, Shuster S. Continuous formation of nail along the bed. Br J Dermatol. 1993;128:277–80.

    Article  CAS  PubMed  Google Scholar 

  5. Yates YJ, Concannon MJ. Fungal infections of the perionychium. Hand Clin. 2002;18:631–42.

    Article  PubMed  Google Scholar 

  6. Hasegawa K, Pereira BP, Pho R. The microvasculature of the nail bed, nail matrix, and nail fold of a normal human fingertip. J Hand Surg [Am]. 2001;26:283–90.

    Article  CAS  Google Scholar 

  7. Moss SH, Schwartz KS, von Drasek-Ascher G, Ogden LL 2nd, Wheeler CS, Lister GD. Digital venous anatomy. J Hand Surg [Am]. 1985;10:473–82.

    Article  CAS  Google Scholar 

  8. Zook EG. Discussion of “nail fungal infections and treatment.” Hand Clin. 2002;18:629.

    Article  Google Scholar 

  9. Smith DO, Oura C, Kimura C, Toshimori K. The distal venous anatomy of the finger. J Hand Surg [Am]. 1991;16:303–7.

    Article  CAS  Google Scholar 

  10. Zook EG. Fingernail injuries. In: Strickland JW, Steichen JB, editors. Difficult problems in hand surgery. St. Louis: CV Mosby; 1982.

    Google Scholar 

  11. Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH. Green’s operative H and surgery. 6th ed. Philadelphia: Elsevier Churchill and Livingstone; 2011. (Chapter 10, The Perionychium;). p. 333–45.

    Google Scholar 

  12. Guy RJ. The etiologies and mechanisms of the nail bed injuries. Hand Clin. 1990;6:9–21.

    CAS  PubMed  Google Scholar 

  13. Zook EG. Reconstruction of a functional and aesthetic nail. Hand Clin. 2002;18:577–94.

    Article  PubMed  Google Scholar 

  14. Seaberg DC, Angelos WJ, Paris PM. Treatment of subungual hematomas with nail trephination: a prospective study. Am J Emerg Med. 1991;9:209–10.

    Article  CAS  PubMed  Google Scholar 

  15. Dean B, Becker G, Little C. The management of the acute traumatic subungual haematoma: a systematic review. Hand Surg. 2012;17:151–4.

    Article  PubMed  Google Scholar 

  16. Gellman H: Fingertip-nail bed injuries in children: current concepts and controversies of treatment. J Craniofac Surg. 2009;20:1033–5.

    Article  PubMed  Google Scholar 

  17. Strauss EJ, Weil WM, Jordan C, Paksima N. A prospective, randomized, controlled trial of 2-Octylcyanoacrylate versus suture repair for nail bed injuries. J Hand Surg Am. 2008;33(2):250–3.

    Article  PubMed  Google Scholar 

  18. Bristol SG, Verchere CG. The transverse figure-of-eight suture for securing the nail. J Hand Surg Am. 2007;32(1):124–5.

    Article  PubMed  Google Scholar 

  19. Weinand C, Demir E, Lefering R, Juon B, Voegelin E. A comparison of complications in 400 patients after native nail versus silicone nail splints for fingernail splinting after injuries. World J Surg. 2014;38(10):2574-9..

    Article  PubMed  Google Scholar 

  20. Schiller C. Nail replacement in fingertip injuries. Plast Reconstr Surg. 1957;19:521–30.

    Article  CAS  Google Scholar 

  21. Johnson RK. Nailplasty. Plast Reconstr Surg. 1971;47:275.

    Article  CAS  PubMed  Google Scholar 

  22. Antony AK, Anagnos DP. Matrix-periosteal flaps for reconstruction of nail deformity. Plast Reconstr Surg. 2002;109:1663–6.

    Article  PubMed  Google Scholar 

  23. Saito H, Suzuki Y, Fujino K, Tajima T. Free nail bed graft for treatment of nail bed injuries of the hand. J Hand Surg [Am]. 1983;8:171–8.

    Article  CAS  Google Scholar 

  24. Shepard GH. Nail grafts for reconstruction. Hand Clin. 1990;6:79–102.

    CAS  PubMed  Google Scholar 

  25. Krusch-Mandl I, Kottstorfer J, Thalhammer G, Aldrian S, Erhart J, Platzer P. Seymour fractures: retrospective analysis and therapeutic considerations. J Hand Surg [Am]. 2013;38:258–64.

    Article  Google Scholar 

  26. Brown RE, Zook EG, Russell RC. Reconstruction of fingertips with combination of local flaps and nail bed grafts. J Hand Surg [Am]. 1999;24:345–51.

    Article  CAS  Google Scholar 

  27. Brown RE. Acute nail bed injuries. Hand Clin. 2002;18:561–75.

    Article  PubMed  Google Scholar 

  28. Hwang E, Park B, Song S, Jung H, Kim C. Fingertip reconstruction with simultaneous flaps and nail bed grafts following amputation. J Hand Surg [Am]. 2013;38:1307–14.

    Article  Google Scholar 

  29. Alagoz M, Uysal C, Kerem M, Sensoz O. Reverse homodigital artery flap coverage for bone and nailbed grafts in fingertip amputations. Ann Plast Surg. 2006;56:279–83.

    Article  CAS  PubMed  Google Scholar 

  30. Rose EH, Norris MS, Kowalski TA, Lucas A, Fleegler EJ. The “cap” technique: non-microsurgical reattachment of fingertip amputations. J Hand Surg [Am]. 1989;14:513–8.

    Article  CAS  Google Scholar 

  31. Baden HP. Regeneration of the nail. Arch Dermatol. 1965;91:619–20.

    Article  CAS  PubMed  Google Scholar 

  32. Krull E, Zook E, Baran R, Haneke E. Nail surgery: a text and atlas. New York: Lippincott Williams & Wilkins; 2001. p. 12. (Chapter 1).

    Google Scholar 

  33. Pardo-Castello V. Disease of the nail. 3rd ed. Springfield: Charles C Thomas; 1960.

    Google Scholar 

  34. Desciak EB, Eliezri YD. Split nail deformities: a surgical approach. Dermatol Surg. 2001;27:252–6.

    CAS  PubMed  Google Scholar 

  35. Clark WE, Buxton LHD. Studies in nail growth. Br J Dermatol. 1938;50:221–35.

    Article  Google Scholar 

  36. Rai A, Jha M, Makhija L, Bhattacharya S, Sethi N, Baranwal S. An algorithmic approach to posttraumatic nail deformities based on anatomical classification. J Plast Reconstr Aesthet Surg. 2014;67:540–7.

    Article  PubMed  Google Scholar 

  37. Pessa JE, Tsai TM, Li Y, Kleinert HE. The repair of nail deformities with the nonvascularized nail bed graft: indications and results. J Hand Surg [Am]. 1990;15:466–70.

    Article  CAS  Google Scholar 

  38. Shepard GH. Perionychial grafts in trauma and reconstruction. Hand Clin. 2002;18:595–614.

    Article  PubMed  Google Scholar 

  39. Lemperle G, Schwarz M, Lemperle SM. Nail regeneration by elongation of the partially destroyed nail bed. Plast Reconstr Surg. 2003;111:167–72.

    Article  PubMed  Google Scholar 

  40. Hanraham EM. The split-thickness skin graft as a covering following removal of a fingernail. Surgery. 1946;20:398–400.

    Google Scholar 

  41. Beasley RW, deBeze GM. Prosthetic substitution for fingernails. Hand Clin. 1990;6:105–11.

    CAS  PubMed  Google Scholar 

  42. Buncke HJ Jr, Gonzalez RI. Fingernail reconstruction. Plast Reconstr Surg. 1962;30:452–61.

    Article  Google Scholar 

  43. Baruchin AM, Nahlieli O, Vizethum F, Sela M. Harnessing the osseointegration principle for anchorage of fingernail prostheses. Hand Clin. 2002;18(4):647–54.

    Article  CAS  PubMed  Google Scholar 

  44. Lille S, Brown RE, Zook EE, Russell RC. Free nonvascularized composite nail grafts: an institutional experience. Plast Reconstr Surg. 2000;105:2412–5.

    Article  CAS  PubMed  Google Scholar 

  45. Endo T, Nakayama Y, Soeda S. Nail transfer: evolution of the reconstructive procedure. Plast Reconstr Surg. 1997;100:907–13.

    Article  CAS  PubMed  Google Scholar 

  46. Morrison WA: Microvascular nail transfer. Hand Clin 6:69–76, 1990.

    CAS  PubMed  Google Scholar 

  47. Morrison WA, O’Brien BM, McLeod AM. Thumb reconstruction with a free neurovascular wrap-around flap from the big toe. J Hand Surg [Am]. 1980;5:575–83.

    Article  CAS  Google Scholar 

  48. Shibata M, Seki T, Yoshizu T, Saito H, Tajima T. Microsurgical toenail transfer to the hand. Plast Reconstr Surg. 1991;88:102–9.

    Article  CAS  PubMed  Google Scholar 

  49. Wilgis EF, Maxwell GP. Distal digital nerve graft: clinical and anatomical studies. J Hand Surg [Am]. 1979;4:439–43.

    Article  CAS  Google Scholar 

  50. Nakayama Y. Vascularized free nail grafts nourished by arterial inflow from the venous system. Plast Reconstr Surg. 1990;85:239–45.

    Article  CAS  PubMed  Google Scholar 

  51. Iwasawa M, Furuta S, Noguchi M, Hirose T. Reconstruction of fingertip deformities of the thumb using a venous flap. Ann Plast Surg. 1992;28:187–9.

    Article  CAS  PubMed  Google Scholar 

  52. Dautel G, Corcella D, Merle M. Reconstruction of fingertip amputations by partial composite toe transfer with short vascular pedicle. J Hand Surg [Br]. 1998;4:457–64.

    Article  Google Scholar 

  53. Endo T, Nakayama Y. Short pedicle vascularized nail flap. Plast Reconstr Surg. 1996;97:656–61.

    Article  CAS  PubMed  Google Scholar 

  54. Endo T, Nakayama Y. Microtransfers for nail and finger tip replacement. Hand Clin. 2002;18:615–22.

    Article  PubMed  Google Scholar 

  55. Koshima I, Soeda S, Takase T, Yamasaki M. Free vascularized nail grafts. J Hand Surg [Am]. 1988;13:29–32.

    Article  CAS  Google Scholar 

  56. Rose EH. Nailplasty utilizing a free composite graft from the helical rim of the ear. Plast Reconstr Surg. 1980;66:23–9.

    Article  CAS  PubMed  Google Scholar 

  57. Achauer BM, Welk RA. One stage reconstruction of the postburn nailfold contracture. Plast Reconstr Surg. 1990;85:937–40.

    Article  CAS  PubMed  Google Scholar 

  58. Kumar VP, Satku K. Treatment and prevention of “hook nail” deformity with anatomic correlation. J Hand Surg [Am]. 1993;18:617–20.

    Article  CAS  Google Scholar 

  59. Koshima I, Moriguchi T, Umeda N, Yamada A. Trimmed second toetip transfer for reconstruction of claw nail deformity of the fingers. Br J Plast Surg. 1992;45:591–4.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nicole Z. Sommer MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Sommer, N., Rymer, M., Schmucker, R. (2015). Injuries to the Nail Apparatus. In: Rozmaryn, L. (eds) Fingertip Injuries. Springer, Cham. https://doi.org/10.1007/978-3-319-13227-3_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-13227-3_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-13226-6

  • Online ISBN: 978-3-319-13227-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics