The basic steps for a nail bed laceration repair are: 1) Perform a digital block, 2) Remove the nail, 3) Repair the laceration, 4) Splint the nail bed and nail fold, using the nail if possible. An adequate tourniquet is necessary to maintain a bloodless field. If the nail remains sufficiently intact, clean it and set it aside. Repair the nail bed with an absorbable small suture. When suturing the nail back in place use a non-absorbable suture. You can preload the sutures through the nail before suturing through the digit (as shown). The non-absorbable sutures through the nail can be removed in 2-3 weeks and the old nail will fall off on its own. This should be enough time for a new nail to start growing in. If the nail is not salvageable, you can apply petroleum infused gauze on the nail bed and suture a nail substitute in place of the nail (eg. the suture packaging). This will protect the nail bed and maintain the space between the nail matrix and proximal nail fold to reduce the chance of deformity. The patient should return for a wound check in 2-3 days and follow up with a hand specialist in 1-2 weeks.