1
|
Iio K, Hanna H, Salter R, Maconochie IK. Should we replace nail plates after repairing nail bed injuries in children? Arch Dis Child 2024:archdischild-2024-327166. [PMID: 38789115 DOI: 10.1136/archdischild-2024-327166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024]
Affiliation(s)
- Kazuki Iio
- Applied Paediatrics MSc course, Imperial College London, London, UK
- Division of Pediatric Emergency Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Heather Hanna
- Section of Paediatric Infectious Disease, Imperial College London, London, UK
| | - Rebecca Salter
- Paediatric Emergency Department, Imperial College London, London, UK
| | - Ian K Maconochie
- Paediatric Emergency Department, Imperial College London, London, UK
| |
Collapse
|
2
|
Braga Silva J. Fingernail injury in children. HAND SURGERY & REHABILITATION 2024; 43S:101512. [PMID: 36682538 DOI: 10.1016/j.hansur.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/30/2022] [Accepted: 01/14/2023] [Indexed: 01/22/2023]
Abstract
Injuries to the nail complex are common in children. Most children who present with fingertip trauma have experienced a crush injury, usually from the hinge side of a door and often in the living room. This article reviews the literature on the management of fingertip crush injuries, fractures of the distal phalanx, nail bed injury and subungual hematoma to establish, where possible, best evidence.
Collapse
Affiliation(s)
- Jefferson Braga Silva
- Service of Hand Surgery and Reconstructive Microsurgery, Pontifical Catholic University of Rio Grande do Sul Hospital São Lucas, Av. Ipiranga, 6690, Centro Clinico PUCRS, Suite 216, Porto Alegre, RS, 90610-000, Brazil; Hospital Moinhos de Vento, Av. Ramiro Barcelos 910, Porto Alegre, RS, 90035-000, Brazil.
| |
Collapse
|
3
|
Dumontier C. Physiology of the nail apparatus: Surgical consequences. HAND SURGERY & REHABILITATION 2024; 43S:101654. [PMID: 38316211 DOI: 10.1016/j.hansur.2024.101654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 02/07/2024]
Abstract
Knowledge of nail physiology is mandatory to understand nail pathologies, and to know what to repair and what to expect from your repair. Unfortunately, nail physiology in humans is not completely understood. However, there are some data that have been validated and must be known before treating patients. The nail plate is mostly made of keratins. It is produced solely by the nail matrix. The nail bed is mostly responsible for nail pate adhesion. At the hyponychium, the plate loses its adherence. The hyponychium is the first barrier of defense preventing bacteria and fungi from invading the subungual area. All these structures, along with the nail folds, are responsible for the orientation of nail-plate growth. However, many questions, such as whether to replace the nail plate at end of procedure, remain open.
Collapse
Affiliation(s)
- Christian Dumontier
- Centre de la Main, Clinique les Eaux Claires, ZAC Moudong Sud, 97122 Baie-Mahault, Guadeloupe, France.
| |
Collapse
|
4
|
Zamour S, Dumontier C. Complications in nail surgery and how to avoid them. HAND SURGERY & REHABILITATION 2024; 43S:101648. [PMID: 38244695 DOI: 10.1016/j.hansur.2024.101648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/26/2023] [Accepted: 12/29/2023] [Indexed: 01/22/2024]
Abstract
Complications in nail surgery are not that frequent. Apart from complications that are common to every hand procedure, intense pain is the major issue with nail surgery. To prevent complications, good knowledge of anatomy and physiology is required to avoid misdiagnosis or inappropriate technique. However, some complications, such as postoperative nail dystrophy, are unavoidable, and must be known and discussed with the patient prior to the procedure in order to prevent disappointment that may lead to medico-legal cases. This paper will discuss the most frequent complications encountered.
Collapse
Affiliation(s)
- Sarah Zamour
- Clinique Les Eaux Claires, ZAC Moudong Sud, 97122 Baie-Mahault, Guadeloupe, France.
| | - Christian Dumontier
- Clinique Les Eaux Claires, ZAC Moudong Sud, 97122 Baie-Mahault, Guadeloupe, France.
| |
Collapse
|
5
|
Dakin HA, Nguyen TTA, Dritsaki M, Greig AVH, Stokes JR, Cook JA, Beard DJ, Davies L, Gardiner MD, Jain A. Cost-effectiveness of replacing versus discarding the nail in children with nail bed injury. Br J Surg 2023; 110:1104-1107. [PMID: 37068916 PMCID: PMC10416701 DOI: 10.1093/bjs/znad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 02/24/2023] [Accepted: 03/13/2023] [Indexed: 04/19/2023]
Abstract
Lay Summary
Every year in the UK, around 10 000 children need to have operations to mend injuries to the bed of their fingernails. Currently, most children have their fingernail placed back on the injured nail bed after the operation. The NINJA trial found that children were slightly less likely to have an infection if the nail was thrown away rather than being put back, but the difference between groups was small and could have be due to chance. This study looked at whether replacing the nail is cost-effective compared with throwing it away. Using data from the NINJA trial, we compared costs, healthcare use, and quality of life and assessed the cost-effectiveness of replacing the nail. It was found that throwing the nail away after surgery would save the National Health Service (NHS) £75 (€85) per operation compared with placing the nail back on the nail bed. Changing clinical practice could save the NHS in England £720 000 (€819 000) per year.
Collapse
Affiliation(s)
- Helen A Dakin
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Thi Thu An Nguyen
- Department of Economics and Related Studies, University of York, York, UK
| | - Melina Dritsaki
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Department of Economics and Laboratory of Applied Economics, University of Western Macedonia, Kastoria, Greece
| | - Aina V H Greig
- Department of Plastic and Reconstructive Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Jamie R Stokes
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jonathan A Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Loretta Davies
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Matthew D Gardiner
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Department of Plastic Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
| | - Abhilash Jain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Department of Plastic Surgery, Imperial College NHS Healthcare Trust London, London, UK
| |
Collapse
|
6
|
Jain A, Greig AVH, Jones A, Cooper C, Davies L, Greshon A, Fletcher H, Sierakowski A, Dritsaki M, Nguyen TTA, Png ME, Stokes JR, Dakin H, Cook JA, Beard DJ, Gardiner MD. Effectiveness of nail bed repair in children with or without replacing the fingernail: NINJA multicentre randomized clinical trial. Br J Surg 2023; 110:432-438. [PMID: 36946338 PMCID: PMC7614411 DOI: 10.1093/bjs/znad031] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/17/2023] [Accepted: 01/21/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Surgery for nail bed injuries in children is common. One of the key surgical decisions is whether to replace the nail plate following nail bed repair. The aim of this RCT was to assess the clinical effectiveness and cost-effectiveness of nail bed repair with fingernail replacement/substitution compared with repair without fingernail replacement. METHODS A two-arm 1 : 1 parallel-group open multicentre superiority RCT was performed across 20 secondary-care hospitals in the UK. The co-primary outcomes were surgical-site infection at around 7 days after surgery and cosmetic appearance summary score at a minimum of 4 months. RESULTS Some 451 children presenting with a suspected nail bed injury were recruited between July 2018 and July 2019; 224 were allocated to the nail-discarded arm, and 227 to the nail-replaced arm. There was no difference in the number of surgical-site infections at around 7 days between the two interventions or in cosmetic appearance. The mean total healthcare cost over the 4 months after surgery was €84 (95 per cent c.i. 34 to 140) lower for the nail-discarded arm than the nail-replaced arm (P < 0.001). CONCLUSION After nail bed repair, discarding the fingernail was associated with similar rates of infection and cosmesis ratings as replacement of the finger nail, but was cost saving. Registration number: ISRCTN44551796 (http://www.controlled-trials.com).
Collapse
Affiliation(s)
- Abhilash Jain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Department of Plastic Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Aina V H Greig
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Amy Jones
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Cushla Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Loretta Davies
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Akiko Greshon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Heidi Fletcher
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Adam Sierakowski
- St Andrew's Centre for Plastic Surgery and Burns, Mid and South Essex NHS Foundation Trust, Chelmsford, UK
| | - Melina Dritsaki
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Thi Thu An Nguyen
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - May Ee Png
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jamie R Stokes
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Helen Dakin
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Jonathan A Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Matthew D Gardiner
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Department of Plastic Surgery, Frimley Health NHS Foundation Trust, Slough, UK
| | | |
Collapse
|