Surgical Site Infection Following Nail Bed Repair with or Without Nail Plate Coverage: A Randomized Clinical Trial

Background: The fingernail plays a vital role in protecting the dorsal fingertip and contributes significantly to hand function and aesthetics. Fingertip injuries represent approximately two-thirds of paediatric hand trauma, with nail bed injuries accounting for 15%–24% of cases. Standard management often involves nail plate removal, nail bed repair, and nail replacement to protect the repair site, reduce infection risk, ease dressing changes, and prevent adhesions. In the absence of the original nail, substitutes such as silver foil or acrylic nails are commonly used. Objective: To compare the incidence of surgical site infection in nail bed repairs performed with and without nail plate coverage. Methods: A two-arm randomized clinical trial was conducted between March 2024 and February 2025. A total of 152 patients with nail bed lacerations were enrolled and randomly assigned to either receive nail plate replacement (foil substitute was used when nail plate was not available) (n=76) or undergo repair without nail bed coverage (n=76). Surgical site infections were monitored postoperatively in both groups. Results: Surgical site infections occurred in 3.9% (3/76) of patients in the nail coverage group and in 2.6% (2/76) of patients in the no-coverage group, with no statistically significant difference. Multivariate logistic regression confirmed that nail coverage was not an independent predictor of infection. Injuries due to road traffic accidents showed a trend toward higher odds of infection (adjusted OR: 15.88, p=0.063), while patients aged 19–35 years demonstrated a significantly lower risk (adjusted OR: 0.037, p=0.031). Conclusion: Nail bed coverage following repair does not significantly reduce the risk of surgical site infection. Omitting nail plate replacement is a safe and cost-effective alternative, simplifying postoperative care without increasing infection risk.