LIN Sessions – Wound Repair

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Nurses Edition Commentary

Mel Herbert, MD MBBS FAAEM, Lisa Chavez, RN, and Kathy Garvin, RN
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Patrick B. -

Great website, very selfless sharing of FOAM and your hard work to help others. http://lacerationrepair.com/

Jason M., PA-C -

A pearl sent to our shop from our nearby ortho clinic: If you end up not using the awesome "spork" technique mentoned in this LIN session and you tack the nail down through the nail bed, use 5-0 chromic gut, rather than Vicryl (braided) or Prolene/Ethilon (very painful to remove).

Michelle Lin, MD -

Hi Jason: Hmm interesting. Didn't think there was a difference between chromic (braided) versus vicryl (braided) - which are both multifilaments. Would have thought that prolene would have been easiest to take out given its slipperiness. Will have to test out... although frankly, I've been gluing the nail in: http://www.aliem.com/trick-trade-nail-bed-repair-tissue-adhesive-glue/ -- so not many opportunities to suture in place.

Thanks for sharing.

Nick J. -

What if there is a tuft fracture underneath the intact nail with a hematoma? In theory this is an open fracture, but could you leave it as is and just splint?

Brian L. -

Hi Nick:
Great question.
If the nail is firmly adherent and disruption of surrounding tissue is minimal, there is likely to be a good cosmetic outcome without primary nail bed repair. However, it may be prudent to at least trephinate the subungual hematoma in this situation. You are right that there is a possibility that this may be an open fracture, which by usual standards typically means thorough washout--so I see your point--but at least in my experience this injury pattern typically heals well with low infection rates.

Jason M., PA-C -

Michelle: (re: November comment - my how time flies) chromic is "twisted multifilament," rather than "braided." Wait, it gets better... it is "ground to have a monofilament character." Prolene may be slippery, but the point is the chromic doesn't have to be removed.

Also - I and another PA have used the "spork technique" multiple times since November and we love it. I keep a photo of the illustration on my smartphone as I forget how to begin every time!

The glue technique at ALiEM looks too darn easy.

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