Nail avulsion occurs when a fingernail or toenail is partially or completely torn away from its underlying nail bed, often due to crush or blunt trauma. This injury exposes the highly sensitive tissue, known as the matrix, which supports nail growth. Because the matrix is delicate and closely linked to the bone, any detachment is considered a serious injury. Successful healing and functional nail regrowth depend entirely on the precise repair of this underlying tissue by a medical professional. Immediate medical attention is necessary to ensure the best possible long-term outcome.
Immediate Care Before Medical Treatment
The first priority following a nail avulsion injury is to control bleeding from the exposed nail bed. Apply gentle but firm, continuous pressure directly to the wound using a clean cloth or sterile gauze for at least ten minutes, without lifting the dressing to check the injury. Elevating the injured hand or foot above the level of the heart also helps slow the flow of blood and minimize swelling.
Once bleeding is controlled, gently cleanse the area using mild soap and running water to remove visible dirt or debris and prevent infection. Avoid using harsh chemical cleansers or strong antiseptics that could further irritate the exposed tissue. If the detached nail piece is recovered, lightly rinse it, wrap it in sterile gauze moistened with water or saline, and place it in a sealed bag.
The preserved nail should be transported with the patient, as it may be useful during the repair procedure. Seek emergency medical care if bleeding is profuse and does not stop after ten minutes of pressure, or if the wound is severe enough that bone is visible. Immediate emergency room attention is also required for any sign of numbness, a change in color, or severe, uncontrolled pain.
Clinical Procedures for Nail Bed Repair
Upon arrival at a medical facility, the injury site is prepared for repair. A local anesthetic, typically a digital nerve block, is used to ensure the patient feels no pain during cleaning and repair. The medical team then thoroughly irrigates the wound with sterile saline solution to remove foreign material and devitalized tissue, a process known as debridement.
To access and repair the damaged nail bed, the remaining nail plate may need to be removed or lifted for full visualization of the sterile and germinal matrix. The delicate matrix tissue, which is responsible for nail growth, is then repaired using very fine, absorbable sutures (e.g., 6-0 or 7-0 thread). This precise suturing is essential to realign the tissue layers and prevent scarring that could cause a permanent nail deformity.
The original detached nail plate, if preserved and clean, is often trimmed and placed back onto the repaired nail bed. This reinserted nail does not truly reattach; rather, it acts as a biological splint to protect the sensitive underlying tissue. The splint maintains the correct space for the new nail to grow out and prevents the skin fold from scarring down to the nail bed. If the original nail cannot be used, a sterile substitute, such as a foil strip or specialized non-adherent dressing, will be placed under the proximal skin fold to serve this splinting function.
Monitoring and Long-Term Healing
Following the procedure, post-operative care is necessary for a successful recovery and healthy nail regrowth. Keeping the repaired finger or toe elevated for the first few days helps minimize swelling and throbbing pain. The dressing placed by the healthcare provider must be kept completely dry, often requiring a plastic covering during showering, and changed only according to professional instructions.
Pain management is typically achieved using over-the-counter pain relievers, but any increasing pain not relieved by medication should be immediately reported. Monitoring the wound for signs of infection is necessary. Symptoms include spreading redness, warmth, increased swelling, or the discharge of pus. A fever or red streaks extending away from the injury site also indicate that urgent medical evaluation is required.
The new nail will grow from the germinal matrix, pushing the splinted old nail or synthetic material forward. This gradual process results in the old nail eventually shedding as the new, healthy nail emerges. Complete regrowth of a fingernail takes approximately six months, while a toenail may require up to a full year for replacement. Damage to the nail matrix can result in a permanent change to the nail’s appearance, such as ridging, splitting, or abnormal thickness (nail dystrophy).