shiny-side down is best for foil splints after nailbed repairs

25. Ljungberg C, Novikov L, Kellerth JO, et al. The neurotrophins NGF and NT-3 reduce sensory neuronal loss in adult rat after peripheral nerve lesion. Neurosci Lett 1999 February 26;262: 29e32. 26. Fu SY, Gordon T. Contributing factors to poor functional recovery after delayed nerve repair: prolonged axotomy. J Neurosci 1995 May;15(5 Pt 2):3876e85. 27. Boyd JG, Gordon T. A dose-dependent facilitation and inhi- bition of peripheral nerve regeneration by brain-derived neurotrophic factor. Eur J Neurosci 2002 February;15: 613e26. 28. Sulaiman OAR, Midha R, Munro CA, et al. Chronic Schwann cell denervation and the presence of a sensory nerve reduce motor axonal regeneration. Exp Neurol 2002 August;176: 342e54. 29. Wu W, Chai H, Zhang J, et al. Delayed implantation of a peripheral nerve graft reduces motoneuron survival but does not affect regeneration following spinal root avulsion in adult rats. J Neurotrauma 2004 August;21:1050e8. 30. Kim DH, Murovic JA, Tiel RL, et al. Infraclavicular brachial plexus stretch injury. Neurosurg Focus 2004 May 15;16:E4. 31. Magalon G, Bordeaux J, Legre R, et al. Emergency versus delayed repair of severe brachial plexus injuries. Clin Orthop Relat Res 1988 December;(237):32e5. 32. Brunelli GA, Brunelli GR. Preoperative assessment of the adult plexus patient. Microsurgery 1995;16:17e21. 33. Narakas AO. The treatment of brachial plexus injuries. Int Orthop 1985;9:29e36. 34. Sedel L. Repair of severe traction lesions of the brachial plexus. Clin Orthop Relat Res 1988 December;(237):62e6. 35. Alnot JY. Traumatic brachial plexus lesions in the adult. Indica- tions and results. Hand Clin 1995 November;11:623e31. 36. Terzis JK, Vekris MD, Soucacos PN. Brachial plexus root avulsions. World J Surg 2001 August;25:1049e61. 37. Kanaya F, Gonzalez M, Park CM, et al. Improvement in motor function after brachial plexus surgery. J Hand Surg [Am ] 1990 January;15:30e6. 38. Dubuisson AS, Kline G. Brachial plexus injury: a survey of 100 consecutive cases from a single service. Neurosurgery 2002 Sep;51:673e83. 39. Kline DG, Judice DJ. Operative management of selected brachial plexus lesions. J Neurosurg 1983 May;58:631e49. 40. Millesi H. Brachial plexus injuries. Management and results. Clin Plast Surg 1984 January;11:115e20. 41. Sunderland S. Nerve and nerve injuries. Edingburgh: Churchill- Livingstone; 1978. 42. Allan CH. Functional results of primary nerve repair. Hand Clin 2000 February;16:67e72. SURGICAL TIP Shiny-side down is best for foil splints after nailbed repairs A variety of splints can be used to hold the nail-fold open after nailbed repair if the original nail plate is not available. A popular option is a piece cut from a foil suture packet. A nailbed thus splinted as shown in Figure 1. Four weeks after the surgery, the wound is stained with green paint that cannot be easily removed. The paint should be scraped from the foil before use, or the splint should be positioned with the shiny side down, despite the natural inclination to have the more aesthetically pleasing shiny side up. Declaration I have no ﬁnancial interests or other conﬂict of interest to declare. James Henderson Department of Plastic and Reconstructive Surgery, Addenbrooke’s Hospital, Box 186, Cambridge, CB2 20QQ,UK ª 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2008.11.098 Figure 1 Paint from a foil suture packet still adherent 4 weeks after nailbed repair and splinting. Reconstruction of brachial plexus injuries 479

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Page 1: Shiny-side down is best for foil splints after nailbed repairs

25. Ljungberg C, Novikov L, Kellerth JO, et al. The neurotrophinsNGF and NT-3 reduce sensory neuronal loss in adult rat afterperipheral nerve lesion. Neurosci Lett 1999 February 26;262:29e32.

26. Fu SY, Gordon T. Contributing factors to poor functionalrecovery after delayed nerve repair: prolonged axotomy. JNeurosci 1995 May;15(5 Pt 2):3876e85.

27. Boyd JG, Gordon T. A dose-dependent facilitation and inhi-bition of peripheral nerve regeneration by brain-derivedneurotrophic factor. Eur J Neurosci 2002 February;15:613e26.

28. Sulaiman OAR, Midha R, Munro CA, et al. Chronic Schwanncell denervation and the presence of a sensory nerve reducemotor axonal regeneration. Exp Neurol 2002 August;176:342e54.

29. Wu W, Chai H, Zhang J, et al. Delayed implantation ofa peripheral nerve graft reduces motoneuron survival butdoes not affect regeneration following spinal root avulsion inadult rats. J Neurotrauma 2004 August;21:1050e8.

30. Kim DH, Murovic JA, Tiel RL, et al. Infraclavicular brachialplexus stretch injury. Neurosurg Focus 2004 May 15;16:E4.

31. Magalon G, Bordeaux J, Legre R, et al. Emergency versusdelayed repair of severe brachial plexus injuries. Clin OrthopRelat Res 1988 December;(237):32e5.

32. Brunelli GA, Brunelli GR. Preoperative assessment of the adultplexus patient. Microsurgery 1995;16:17e21.

33. Narakas AO. The treatment of brachial plexus injuries. IntOrthop 1985;9:29e36.

34. Sedel L. Repair of severe traction lesions of the brachialplexus. Clin Orthop Relat Res 1988 December;(237):62e6.

35. Alnot JY. Traumatic brachial plexus lesions in the adult. Indica-tions and results. Hand Clin 1995 November;11:623e31.

36. Terzis JK, Vekris MD, Soucacos PN. Brachial plexus rootavulsions. World J Surg 2001 August;25:1049e61.

37. Kanaya F, Gonzalez M, Park CM, et al. Improvement in motorfunction after brachial plexus surgery. J Hand Surg [Am ]1990 January;15:30e6.

38. Dubuisson AS, Kline G. Brachial plexus injury: a survey of 100consecutive cases from a single service. Neurosurgery 2002Sep;51:673e83.

39. Kline DG, Judice DJ. Operative management of selectedbrachial plexus lesions. J Neurosurg 1983 May;58:631e49.

40. Millesi H. Brachial plexus injuries. Management and results.Clin Plast Surg 1984 January;11:115e20.

41. Sunderland S. Nerve and nerve injuries. Edingburgh: Churchill-Livingstone; 1978.

42. Allan CH. Functional results of primary nerve repair. Hand Clin2000 February;16:67e72.

Reconstruction of brachial plexus injuries 479

SURGICAL TIP

Shiny-side down is best for foil splints after nailbedrepairs

A variety of splints can be used to hold the nail-fold openafter nailbed repair if the original nail plate is not

available. A popular option is a piece cut from a foilsuture packet.

A nailbed thus splinted as shown in Figure 1. Fourweeks after the surgery, the wound is stained with greenpaint that cannot be easily removed.

The paint should be scraped from the foil beforeuse, or the splint should be positioned with the shinyside down, despite the natural inclination to have themore aesthetically pleasing shiny side up.

Declaration

I have no financial interests or other conflict of interestto declare.

James HendersonDepartment of Plastic and

Reconstructive Surgery,Addenbrooke’s Hospital, Box 186,

Cambridge, CB2 20QQ,UK

ª 2009 British Association of Plastic, Reconstructive andAesthetic Surgeons. Published by Elsevier Ltd. All rightsreserved.

doi:10.1016/j.bjps.2008.11.098

Figure 1 Paint from a foil suture packet still adherent 4weeks after nailbed repair and splinting.

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