Clover-leaf suture for securing the nail

摘要

Dear Sir, Nail bed injuries are very commonly seen by hand surgery units. The nail plate may be avulsed or requires removal to provide access to the subungal matrices, for assessment and repair. Following reconstruction the nail plate must be placed back under the eponychial fold to prevent adherence of the nail fold and pterygium (advancement of skin over the nail plate). Many methods have been described to secure the nail plate in place. Schiller (1957) described a horizontal mattress suture but this does not secure the nail plate distally and the nail plate can slide out. A modification of this technique (Bristol and Verchere, 2007) aimed to solve this problem by securing the plate by notches distally but this still allows slippage if not tightened correctly. Bindra (1996) described the use of a longitudinal figure-of-eight suture. However this requires the needle to be passed close to, if not through, the germinal matrix of the nail bed and the technique is also difficult to use if the eponychium has been damaged. Tissue glue has also been used (Richards et al., 1999). The following technique provides secure fixation of the nail plate under the eponychium without damaging the germinal matrix.