A simulation model of nail bed suture and nail fixation: description and preliminary evaluation

Wounds of the finger nail bed represent a frequent injury, especially in children. Residents often learn nail bed repair on patients without prior training. We aimed to develop and evaluate a "low-fidelity" simulation model of nail bed repair.

The model consists of a false nail on a plastic finger and a hydrocolloid dressing, which is pasted on the nail bed site and cut horizontally. This model allows nail bed suture and nail fixation. The cost of each model is about $1. Thirty-three doctors evaluated this model on 10 items, rated out of five, concerning the realism, the difficulty of the procedure, and the educational value. The duration of the procedure was also noted. We evaluated the clinical effectiveness by comparing through Fisher's exact test the ratio of unsuitable events (revision surgeries, surgical site infections, and complaint letters) on two periods-3 y before and 18 mo after the implementation of this model in our institution, respectively.

Average mark was 4.16/5. The model was considered reliable, reproducible, and realistic. All the testers recognized a big educational value. The overall duration of the procedure averaged 23 min for residents and 11 min for surgeons. We collected 17 unsuitable events out of 84 patients from the period "before" and 2 out of 54 patients from the period "after" (P = 0.005). Revision surgeries were 10/84 from the period before and 2/54 from the period after (P = 0.04).

The results of the internal and clinical evaluations are encouraging. We suggest integration of this model into the training program of residents.