After Fingertip / Nail Bed Repair

What was done

The injured fingertip was cleaned and any lacerations were repaired. Depending on the specific injury, one or more of the following was performed:

• Repair of the nail bed (the pink tissue under the fingernail) with absorbable stitches
• Replacement or suturing of the fingernail (or a small splint where the nail used to be) to protect the healing nail bed
• Repair of a fingertip skin laceration
• A small skin graft to cover a missing area of skin
• A local flap (moving a nearby piece of skin with its blood supply into the defect)
• Shortening and closure of a completely amputated fingertip (a "revision amputation")

You have a bulky dressing over the finger to protect the repair and absorb drainage.

The first 5 to 7 days

• Keep the dressing on, clean, and dry. Do not peel layers off to "check" the wound early — the dressing is part of the healing.
• Keep the hand elevated above the level of your heart as much as possible. This is especially important after a fingertip injury, which can throb significantly if left hanging down.
• Some drainage of pink-tinged fluid through the dressing is normal in the first 48 hours. A small amount of blood staining is also common.
• Use the hand for light activity only. Do not grip, push, or soak.
• No lifting more than 5 pounds with the affected hand for the first 2 weeks.

Day 5 to 7: dressing change

• Come to the office or a minor procedure room at 5 to 7 days for the first dressing change. Do not change the dressing yourself unless specifically instructed.
• If the dressing has become soaked through and you cannot be seen that day, reinforce it with extra gauze and tape and call the office.

After the first dressing change

• From this point on, the wound is usually cared for with daily soaks and bandage changes at home.
• Daily soak: soak the finger in a mix of warm water and a small amount of mild soap (or hydrogen peroxide if we suggested it) for 5 to 10 minutes, once or twice a day. Pat dry with a clean towel.
• Apply a thin layer of plain antibiotic ointment (bacitracin or an equivalent) or petroleum jelly.
• Cover with a non-stick pad and wrap with a finger bandage or tubular gauze.
• Continue this daily until the wound is fully closed, typically 2 to 4 weeks.

Pain and expected symptoms

• Throbbing pain in the first 24 to 48 hours is common. Elevation, ice (over the dressing — never directly on skin after surgery), and over-the-counter pain medicine usually control it.
• Severe, increasing throbbing that is not controlled by medication and elevation may mean the bandage is too tight — see below.
• Cold sensitivity in the fingertip is very common after fingertip injuries and can last for months. It almost always improves gradually.
• The fingertip may feel "numb" or "tingly" for weeks to months as small nerves in the area recover.

Nail growth — the long timeline

• Fingernails grow slowly — about 1 mm per week. A full new nail takes about 4 to 6 months to grow out completely.
• If the old nail was replaced as a splint, it usually falls off on its own at 2 to 4 weeks as the new nail grows underneath.
• The new nail often looks ridged, thicker, or slightly different for the first several months. Most nails eventually grow in looking essentially normal.
• A permanent nail deformity is possible after certain nail bed injuries, particularly those with significant crush injury or delay in repair.

Desensitization

After the wound is fully closed, if the fingertip remains hypersensitive to touch, start a simple desensitization routine: rub the fingertip on progressively rougher textures (soft cotton, washcloth, soft brush, coarse fabric) for 2 to 3 minutes, several times a day. The nervous system retrains itself over weeks to a few months.

Activity

• Driving: when the pain is controlled with over-the-counter medicine and you can hold the wheel comfortably — usually 2 to 5 days.
• Typing / desk work: as tolerated from a few days in; avoid pressing firmly on the injured fingertip.
• Return to light work: usually within a week.
• Return to manual work: 3 to 4 weeks, once the wound is closed.
• Return to wet or dirty work (gardening, dishwashing): once the wound is fully closed, usually 3 to 4 weeks, with gloves for an extra couple of weeks.

Follow-up

First dressing change at 5 to 7 days. Follow-up at 2 to 3 weeks for suture removal (if non-absorbable sutures were used) and a check of wound healing. Final follow-up at 6 weeks.

Related

About fingertip injuries · Nail bed injuries · Home hand therapy

Questions?

Call your office location for non-urgent questions:

• NYU Langone Laurelton · 646-501-4950
• NYU Orthopedic, Woodside · 929-429-3222
• NYU Orthopedic, Richmond Hill · 718-206-6923
• Jamaica Hospital Ambulatory Care Center (ACC) · 718-301-0720

See our office contact information for addresses and fax numbers.