Finger or toe nailbed repair advice leaflet

Paediatric pre and post-operative advice for day surgery patients

What is a nailbed injury?

The nailbed is the skin underneath the nail, which helps the nail to grow.

A nailbed injury happens when the fingertip or toe is caught between two objects (crush injury) or through a cut with a sharp object, or through catching the nail and it coming off the nailbed.

Why repair a nailbed?

Repairing the nailbed can help to reduce pain, reduce risk of infection, help the nailbed’s healing time and reduce the risk of a deformed nail growing back through.

Before the day of your child’s operation.

Your child will need to be assessed by the children’s pre-assessment clinic. This will either be face to face or via a telephone call. This is to check that your child is fit and well for the anaesthetic and if there is a need to refer to an anaesthetist to review prior to the day of surgery. You will also be given fasting times for the day of surgery: no food 6 hours prior to admission time, no breast milk 4 hours prior to admission time and no clear fluids 2 hours prior to admission time.

You will be contacted by the admissions team, who will give you a date and time to come in for your child’s operation.

Please make sure that you have a supply of paracetamol and ibuprofen (if your child can take these) at home to give after the operation. These are not routinely given to you to take home after the operation.

If your child is unwell prior to surgery please contact the admissions team to make them aware of this, as surgery may need to be postponed if it will be taking place under general anaesthetic.

On the day of surgery

When your child arrives on the ward

Please arrive on the ward on the correct date and at the correct admission time for your child’s planned surgery. Please make sure that the fasting instructions have been followed otherwise the procedure may not be able to go ahead as planned.

The time of admission is not the time that your child will go down to surgery. This is determined by the age and clinical need of the patients.

A nurse will admit your child to the ward. This includes checking you child’s details, whether they have any allergies and their temperature, pulse and blood pressure. Depending on your child’s age numbing cream may be applied to both their hands, if they are going to be asleep during the operation.

You will see the surgical team who will gain written permission (consent) from you to say you are happy for the procedure to go ahead. Prior to you signing this the surgical team will discuss what the procedure involves and the risks and benefits of carrying out the surgery. You will also be able to ask any questions that you may have about the procedure.

The anaesthetist will also see you and your child prior to going to theatre. They will check that your child is medically fit for the procedure and for general anaesthetic (if your child is having this). They will also discuss with you the different ways that anaesthetic can be given, and which method would be best for your child.

In theatre

You can accompany your child to the anaesthetic room if your child is having general anaesthetic.

Once your child is asleep a member of staff will take you to recovery, where the recovery staff will take a phone number to contact you on when your child comes out of theatre.

You will not be able to go into theatre with your child.

If your child did not have a cannula inserted in their hand in the general anaesthetic was given, they will have one inserted once they are asleep, this is so medications can be given during the operation and also after surgery if required.

The area to be operated on will be cleaned. If the nail is still attached, the nail will be removed, and the nailbed will be cleaned. The damage to the nailbed will then be assessed. Any cuts to the nailbed and to the surrounding skin will be stitched using fine dissolvable stitches. A dressing will then be applied to the finger and if your child is young they will also have a bandage applied to the area to keep the dressing on.

During the surgery your child will be given pain relief, anti-sickness medication and fluids.

After the operation

You will be contacted by the children’s recovery team to inform you that your child is in recovery.

After the surgery your child may feel drowsy or sleepy, and they may be restless and upset after waking from the anesthetic (this normally settles on its own).

Your child can eat and drink as they feel able to after the procedure.

Your child will have a dressing covering the finger that was operated on. There may be swelling, bruising or soreness to the area, and these will settle over the following days/weeks.

You may go home once your child has eaten, drunk and passed urine. We will also make sure that your child is comfortable after the procedure, before you go home.

After you go home

Paracetamol and ibuprofen should be given regularly for the first couple of days.

Try to encourage your child to elevate their hand as much as possible, this will help with swelling and pain.

The dressing will need to be kept dry, until the wound is reviewed. If the dressing comes off, please contact the children’s plastic surgery nurses or attend your GP.

It is normal for the wound to ooze after the surgery, if at home and you see any fresh blood on the wound or the plaster, please attend your GP. If a plaster has been placed over the wound, this can normally be removed at home or by the practice nurse at your GP surgery (if they need to have the wound checked). After removing the dressing, a small plaster can be applied if needed, and your child should be encouraged to use the hand as normal.

Once the stitches have come out, you should moisturise and massage the scar with simple, unscented moisturiser. This should be done a minimum of two times a day.

The nail normally takes 6 months to fully grow back. The nail may have a bump or ridge the first few times that it grows through.

Signs of infection

• Redness around the wound or spreading away from the wound.
• Increased pain to the wound that is out of proportion to the surgery carried out.
• Hot to touch, when compared with the temperature of the surrounding skin.
• A foul smell coming from the wound.
• Pus or excessive oozing from the wound.
• Your child has a temperature and feels unwell

If any of these signs appear please contact your GP, but if your child is very ill take them straight to A&E.

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

If you are interested in this please let us know and we can provide information, or look on our website: MyChart

Contacts/further information

Paediatric Plastic Surgery CNS: 07729 107964

Email the paediatric plastics department

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one to one care is required.