![]() ![]() Acute infections often result from a minor event, such as a superficial laceration or pulling a hangnail, with bacteria - typically Staphylococcus and Streptococcus - being the most common etiology. The nail is a site for both acute and chronic infections. The nail is shown growing around the tip of the finger. When the nail bed loses its distal support, the nail can grow downward around the tip of the finger.įigure 4: Hook nail. ![]() This option is advantageous in the pediatric population specifically because it avoids keeping the child motionless and is relatively pain-free.Ī hook nail deformity is a condition that can appear after a traumatic amputation of the distal aspect of the fingertip (that is, soft tissues and the tuft of the distal phalanx). The cosmetic outcome with this approach is comparable to that of suture repair. In children, it may be possible to repair the nailbed with a cyanoacrylate adhesive (e.g., "Dermabond"). Without adequate repair (and sometimes despite best efforts) the nailbed will not heal smoothly.īecause nailbed lacerations are typically crush injuries, x-rays should always be obtained to exclude a fracture. Nailbed lacerations are often the result of crush injuries, producing a stellate laceration pattern. The cuticle is a layer of epidermis that folds back over the surface of the nail plate at its base. The eponychium is a small band of epithelium that covers the proximal aspect of the nail the paronychium is a similar border tissue around the medial and lateral borders. As these cells are produced, older cells are pushed forward and compressed, giving rise to the typical growing pattern of the nail. Within the nail bed is the germinal matrix, the source of cells that become the nail plate. So-called “capillary refill” indicates good flow.) (The function of these blood vessels can be assessed by compressing the nail to momentarily occlude them, and then releasing the pressure. The nail bed contains nerves, lymphatics and capillaries. The nail bed is the tissue that lies beneath the nail plate. The nail plate (which, in layman’s terms, is the “nail” itself) is a hard sheet of translucent keratin in which lie several layers of dead, compacted cells. The nail is a plate of keratin that covers the dorsal aspect of the distal phalanges of the fingers and toes (Figure 1). Last, the nail may display signs of underlying systemic disease. The nail is also susceptible to infection and may be the site of tumors, both benign and malignant. The fingernail is the most frequently injured portion of the finger secondary to its prominent location. In addition to protecting the fingertip, it provides tactile sensation, aids in thermoregulation, and assists in picking up small objects it also has dense lymphatics in the hyponychium that help resist infection. The fingernail serves multiple functions. ![]()
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