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Difficult adherent nail bed dressings: An escape route
  1. M S Ul Hassan,
  2. R Y Kannan,
  3. N Rehman,
  4. A J Platt
  1. Department of Plastic Surgery, Castle Hill Hospital, Hull, UK
  1. Correspondence to:
 Mr Ruben Y Kannan
 Research Fellow, Department of Academic Surgery, Royal Free Hospital, Pond Street, London NW3 2QG, UK; ykrubenyahoo.com

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Post-operative management of nail bed injuries is an especially annoying problem for both medical personnel and patients.1 This is due to two main reasons. Firstly, the nail bed is an extremely sensitive organ especially in the acute stage. Secondly, some dressings like Jelonet™ tend to adhere to them causing distress to the patient. In children, this can sometimes mean either a local block or even general anaesthesia, which is an unnecessary risk.

In our practice, we use a simple technique to remove adherent nail bed dressings. The injured finger is dipped into 20 ml of an undiluted 1% solution of plain lignocaine for approximately 20 minutes. We find that these dressings can then be easily removed from the nail bed through the topical effect of lignocaine. There were no instances of systemic lignocaine toxicity in our experience. This process is facilitated by macerated periungual skin and the good vascularity of the nail bed.

It must be mentioned that the gold standard dressing in nail bed surgery is non-adherent dressings like Mepetal™. However, in clinical practice, one occasionally comes across adherent dressings, typically in the follow-up clinics. In such situations, topical application of readily available local anaesthetics averts the crisis of having an unnecessary general anaesthetic and the allows pain-free removal of dressings, irrespective of the type used.2 For medical personnel particularly in the casualty setting, it would save time and money as well as minimise psychological stress.

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  • There is an error in the name of the first author of this paper. The first author's name should read: Hassan, M S U.

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