Randomized controlled trial comparing frequency of post operative infection in patients undergoing nail bed repair with nail replacement versus non replacement

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Author(s): Sobia Yasmeen, Moiz Sadiq, Mirza Shehab Afzal Beg

Pages: 20-29 |

Finger tip entrapment m Junes are common in children and represent approximately two thirds of all the hand injuries in children. The nail plate is crucial for normal functioning of hand; it protects from injury to fingertip, regulates the circulation of fingertip, helps to hold small objects by giving counterforce and adds to the tactile sensation of fingertip. If not treated properly, nail complex injury can potentially cause considerable dysfunction and/or deformity.Despite the common occurrence, controversy remains around the appropriate treatment of nail bed injuries. Objective: To compare the frequency of post operative infection in patient undergoing nail bed repair with nail replacement versus non replacement Materials and Methods: It was a Randomized controlled trial conducted at the Emergency and outpatient department of plastic and reconstructive section of Liaquat national hospital, Karachi. Total 152 patients with acute nail bed injury were included in this study. These patients were randomly allocated into two groups, 7 6 patients in group A received nail replaced after nail bed repair and 76 patients in group B had the nail discarded. Post operatively all patients were given antibiotic for three days. Participating patients were advised to attend plastic surgery clinic for the assessment of post operative infection at one week after surgery. Results: Mean age of the patients in group A was 8.98±4.59 years and in group B was 7.01±4.02 years. Rate of post-operative infection was significantly high in group A than to group B (38.16% vs. 21.05%; p=0.021). Conclusion: Management of a fingernail injury should be selected on the basis of injury type and extent, and requires accurate knowledge of nail anatomy and physiology. Nail replacement after nail bed repair is controversial and resulted in increased morbidity, but long term results of nail replacement are not available and need further studies.