Nail Gun Injuries: A Simple Method to Facilitate Exploration

BACKGROUND

Nail gun injuries to the hand, fingers and wrist are commonly sustained by younger manual workers¹ who rely heavily on the function of their hand. Classical treatment for penetrating injury with associated foreign body is to lay open the entire tract, to enable adequate wound toilet and identification of damaged structures.² We describe a technique to facilitate both exploration and irrigation of the tract.

TECHNIQUE

Before removal of the nail, a robust suture (for example a 2/0 nylon) is tied around the distal end (Fig. 1). Antiseptic solution is applied to the nail, which is then removed, pulling the suture into the tract (Fig. 2). An exploratory incision is made, taking care to plan the incision to allow for extension for further surgical exploration as necessary. Damaged structures in the vicinity of the nail can be visualised and repaired; adequate irrigation can be performed, using a modified Seldinger approach³ by threading an intravenous cannula over the 2/0 nylon tie into the tract of the nail, whilst minimising unnecessary surgical access incisions and their associated morbidity (Fig. 3).

Figure 1.

A suture is tied around the nail.

Figure 2.

The suture is pulled into the tract.

Figure 3.

The suture allows identification of the tract during treatment.

DISCUSSION

While we strongly endorse adequate exposure and debridement in contaminated wounds with foreign body involvement, in selected cases this technique allows visualisation of the tract, allowing directed debridement and irrigation thus minimising the risk associated with larger surgical wounds, without compromising treatment.