Nail Splints to Prevent Dorsal Pterygium After Nail Surgery: Indications and Optimal Selection

After trauma or a variety of nail surgical procedures, there is potential for nail unit epithelium to directly contact dermal connective tissue, putting the nail unit at risk for a bridging scar and resulting dorsal pterygium. To prevent a dorsal pterygium, a variety of materials, including the native nail, have been proposed to splint the proximal nail fold (PNF) and nail matrix (NM).

To review the indications, materials, and techniques for intraoperative nail splinting during nail unit surgery.

A comprehensive review of nail splints was conducted in PubMed and OVID Medline.

There are a variety of materials that can be utilized to splint the PNF and NM with various securing techniques. Ideally, this is done with the native nail plate; however, if the native nail plate is unavailable, one can utilize a synthetic nail splint.

If there is trauma or surgery to the nail unit that results in dermal-dermal or dermal-epithelial apposition, it is recommended to splint the sulcus of the PNF from the underlying NM and/or bed during the first 2 to 3 weeks postoperatively. Splinting helps prevent scarring of these opposing tissues and a resulting dorsal pterygium.