A simulation model of nail bed suture and nail fixation: description and preliminary evaluation

Background: Wounds of the finger nail bed represent a frequent injury, especially in children.Residents often learn nail bed repair on patients without prior training. We aimed todevelop and evaluate a “low-fidelity” simulation model of nail bed repair.Methods: The model consists of a false nail on a plastic finger and a hydrocolloid dressing,which is pasted on the nail bed site and cut horizontally. This model allows nail bed sutureand nail fixation. The cost of each model is about $1. Thirty-three doctors evaluated thismodel on 10 items, rated out of five, concerning the realism, the difficulty of the procedure,and the educational value. The duration of the procedure was also noted. We evaluated theclinical effectiveness by comparing through Fisher’s exact test the ratio of unsuitableevents (revision surgeries, surgical site infections, and complaint letters) on two periodsd3y before and 18 mo after the implementation of this model in our institution, respectively.Results: Average mark was 4.16/5. The model was considered reliable, reproducible, andrealistic. All the testers recognized a big educational value. The overall duration of theprocedure averaged 23 min for residents and 11 min for surgeons. We collected 17 unsuitableevents out of 84 patients from the period “before” and 2 out of 54 patients from theperiod “after” (P ¼ 0.005). Revision surgeries were 10/84 from the period before and 2/54from the period after (P ¼ 0.04).Conclusions: The results of the internal and clinical evaluations are encouraging. We suggestintegration of this model into the training program of residents.