Nail Bed Repair
Also known as: nail bed reconstruction or nail bed restoration
Nail bed repair is a minor surgical procedure to treat injuries to the nail bed – the layer of tissue under the fingernail or toenail that helps the nail grow.
What is the nail bed?
The nail bed is a thin layer of tissue under the toenail or the fingernail that helps the nail grow and support itself. Injuries to this area are common and often happen when fingers or toes are crushed by heavy objects like doors or machinery, which can damage the nail bed and surrounding tissues. Seek medical attention immediately if you suspect a nail bed injury, as early treatment can help reduce complications and promote healing. The nail bed consists of the germinal matrix, which generates new nail cells, and the sterile matrix, which anchors and supports the nail plate.
Nail plate relationship
The nail plate protects the underlying structures of the fingertip, including the nail bed and distal phalanx (bone at the tip of each finger and toe). It can also act as a natural splint for associated fractures, promoting healing and reducing post-procedural pain. The nail matrix is important in nail bed injuries, as injuries to this area can cause scarring and may require matrix repair or replacement. Proper management of the nail plate and matrix is key to optimal recovery and function.
Types of injuries
Nail bed injuries can range from minor cuts to more severe damage, where the nail is completely torn off. These types of injuries need careful treatment to help the nail grow back properly and to avoid long-term problems with the nail’s appearance or function. Nail bed injuries often occur with other issues like broken or dislocated finger bones, which can make treatment more complicated.
What is nail bed repair?
Nail bed repair is a minor surgical procedure to treat injuries to the nail bed – the layer of tissue under the fingernail or toenail that helps the nail grow. It’s done when the nail bed is lacerated, crushed or damaged due to trauma such as a heavy object falling on your finger or toe, or a deep cut. During the procedure, the damaged nail (or fragments) is removed to access the nail bed, which is then cleaned and stitched with fine absorbable sutures to promote healing and reduce nail deformities. In some cases, the original nail or a protective splint is placed over the repair site to shield it while the new nail grows in. The goal is to restore both the appearance and function of the nail and minimise long-term complications.
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Ways to payBefore surgery
Initially, you’ll see a hand specialist or a podiatrist to evaluate the injury to your nail. This may be in an emergency or clinic setting, depending on how the injury occurred. After examining your finger or toe (possibly with an X-ray to check for fractures), your doctor will decide if nail bed repair is needed.
Before undergoing nail bed repair surgery, follow the guidelines to help ensure a smooth procedure and recovery. Your doctor will provide you with specific instructions, but here are some general tips to keep in mind. If the procedure is performed under general anaesthesia, you will need to fast for a period before surgery. Inform your doctor about any medications you are taking, as some may need to be stopped or adjusted before surgery. Also, since you won’t be able to drive yourself afterwards, arrange for someone to take you home.
By following these general guidelines and your doctor’s specific instructions, you can help ensure a good outcome and smooth recovery.
During surgery
Nail bed repair is a minor surgical procedure and is usually done under local anaesthesia for adults. However, in young children, general anaesthesia is often used to ensure comfort and cooperation during the procedure.
The first step in surgical repair is to thoroughly clean the wound to prevent infection. Then the surgeon will realign the nail bed tissues and secure them in place with fine sutures. This meticulous approach minimises scarring and promotes optimal healing.
In some cases, the surgeon may need to remove the damaged nail plate to access the underlying nail bed. This allows for a more comprehensive repair but also introduces additional risks.
After surgery
Immediate post-surgery care
After nail bed surgery, follow your surgeon’s instructions carefully to ensure healing. This means keeping the area clean and dry, taking prescribed medications and attending follow-up appointments. Dressings or bandages are applied to protect the finger and should only be changed as directed by your healthcare provider. Don’t get the finger wet until you are told it’s safe – this may mean covering the hand or foot while bathing.
Pain, swelling and mild bruising are common in the first few days and can be managed with prescribed or over-the-counter pain medications. Elevate the limb above heart level, especially in the first 48 hours, to reduce swelling and discomfort.
Your doctor may prescribe antibiotics if there is a higher risk of infection, especially in open injuries. Take all medications as prescribed and report any signs of infection such as increased redness, warmth, discharge or fever.
Long-term recovery
Long-term recovery from nail bed surgery is a gradual process to restore both function and appearance to the affected finger or toe. Adhering to post-operative care instructions is key to successful healing. Your doctor may prescribe specific exercises to prevent stiffness, promote circulation and maintain flexibility. In some cases, physical therapy may be recommended to restore the full range of motion.
Nail growth will resume within a few weeks, and monitoring this process is important. Report any abnormalities in growth, such as discolouration or deformity, to your healthcare provider. Protect the healing area from further trauma; avoid heavy lifting or contact sports until full recovery is achieved.
Routine follow-up appointments allow healthcare providers to assess healing and manage any issues early. These visits are important to evaluate both cosmetic and functional outcomes, and you should communicate any concerns about nail appearance.
As with any surgery, there are risks of complications. These can include infection, scarring, nail deformity or even permanent loss of nail structure. Infections can occur from inadequate wound care and typically require antibiotic treatment. Scarring and deformities are more likely with severe or poorly managed injuries and can impact both appearance and function. Other possible issues include chronic pain and reduced finger mobility. Following proper aftercare and attending all scheduled check-ups minimises the risk of these complications.
Appointment and Treatment Plan
Initial Consultation
You’ll see a hand specialist or a podiatrist to evaluate the injury to your nail. This may be in an emergency or clinic setting, depending on how the injury occurred. After examining your finger or toe (possibly with an X-ray to check for fractures), your doctor will decide if nail bed repair is needed.
Treatment Planning
If surgery is recommended, your provider will explain the procedure, risks, benefits and expected recovery. Nail bed repair is done for injuries involving deep cuts, crushed nails or nail detachment, especially if the nail matrix is damaged and proper healing is unlikely without intervention.
Pre-Operative Assessment
Before the procedure, you may have a brief health screening or physical exam to ensure you’re safe for anaesthesia. In children, general anaesthesia is often used; in adults, local anaesthesia is used to numb the area.
Surgery Day
On the day of your procedure, the injured nail (or any remaining fragments) may be removed to access the nail bed. The surgeon will then clean the area and repair the nail bed with tiny absorbable stitches. Sometimes, a special splint or the original nail is placed over the nail bed to protect it as it heals. Most procedures are completed within an hour and are performed on an outpatient basis.
Recovery
After surgery, your finger will be bandaged, and you may be given a splint or covering. You’ll need to keep the finger elevated, clean and dry for the first few days. Pain and swelling are common but can be managed with over-the-counter pain relievers and rest. You may need a follow-up visit in 1-2 weeks to check healing and remove or change dressings. New nail growth will start within a few weeks, but full regrowth may take several months. Avoid trauma and follow aftercare instructions for the best results. In some cases, physical therapy may be recommended to prevent stiffness and promote mobility.
Experts
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FAQs
Yes, a damaged nail bed can be repaired, especially with prompt and proper medical intervention. The success of the repair depends on the extent and nature of the injury. Simple nail bed injuries, such as minor lacerations or subungual hematomas, can heal with minimal intervention. More severe injuries, such as crush injuries or nail bed avulsions, usually require surgical repair to restore the nail bed’s structure and function. During the procedure, the nail bed is meticulously realigned and sutured, often with fine absorbable sutures, to minimise scarring and promote optimal healing. With proper care and follow-up the nail bed can recover, and normal nail growth will occur over time.
In many cases, nail bed damage can be reversed, especially if the injury is addressed promptly and properly. Early treatment is key to preventing long-term complications such as permanent deformity or nail loss. Simple injuries may heal on their own, but more complex cases, especially those involving the nail matrix or associated fractures, may require surgical intervention. The goal of treatment is to restore the nail bed’s integrity and function to allow normal nail growth and appearance. While some scarring or deformity may occur in severe cases, timely medical attention can improve outcomes and reduce the risk of permanent damage.
Nail bed surgery is usually indicated when there is significant damage to the nail bed that cannot heal on its own. This includes cases of severe lacerations, crush injuries or when the nail plate is avulsed. Surgery may also be necessary when there are associated fractures of the distal phalanx or if the injury involves the germinal matrix, as these can affect nail growth and appearance. The decision to proceed with surgery is often based on the extent of the injury, the presence of complications and the potential for better healing and cosmetic outcome. Surgical intervention aims to repair the nail bed, promote normal nail growth and prevent long-term deformities.
Medically reviewed by Mr Jonathan Larholt - Consultant Podiatric Surgeon on 29/05/2025