Scratches from Fingernails (Children Playing), Suturing and Taping

Today, a 5-year-old boy came in after sustaining a cheek injury from a fingernail while playing with other children. His mother first asked if the scar could be completely removed. However, while all tissues in our body are capable of perfect regeneration in the fetal state, once born and matured, only bone, internal organs, and oral mucous membranes possess perfect regenerative capabilities. Other tissues heal with scar tissue, and skin is no exception. However, as mentioned previously, the healing period and the extent of the resulting scar are determined by how deeply the dermis, the deeper of the two skin layers, has been damaged.

From the perspective of dermal damage, we can distinguish between cases where the dermis is deeply damaged and cases where it is broadly damaged. If the dermis is deeply damaged, the first thing to ascertain is whether there is damage to the functional tissues beneath the dermis and if foreign bodies have entered under the skin. If there is significant damage to functional tissues, and the symptoms are severe, then skin suturing is not the primary concern; restoring functional tissues takes precedence, and this is not a case to be handled at a clinic level. Furthermore, if foreign bodies have entered, they must be removed. Even the patient's own hair or tooth fragments, if not originally meant to be under the skin, should be identified as foreign bodies and removed.

When the dermis is deeply damaged, the wound will inevitably gape open. In such cases, our body induces appropriate hemostasis and inflammatory responses, forming a special tissue called granulation tissue, rather than normal dermis. This consists of well-developed small blood vessels and collagen fiber bundles formed by fibrous tissues, all for the purpose of healing. These collagen fiber bundles are later replaced by what is known as scar tissue.

So, what about closing such a gaping wound with something to minimize its width and depth? Yes, the technique performed for this purpose is called suturing. Through suturing, the width and depth are minimized, prompting our body to produce as little granulation tissue as possible. The benefit of suturing is that the amount of granulation tissue is reduced, shortening the healing period and significantly reducing the amount of tissue replaced by scar tissue.

In this patient's case, the injury was a scratch from another child's fingernail during play. There was some invasion of the dermal layer, but it was only about 2-3mm in scattered spots along the total length; the rest was epidermal damage, not dermal. Therefore, instead of suturing, skin closure tape (Steri-strip, 3M) was applied to narrow the width as much as possible, and the patient was asked to return in 4-5 days, around the time granulation tissue would form. I explained that, given the minor depth and extent of the wound as mentioned earlier, the long-term outcome would likely be a small scar that would be barely noticeable in casual conversation.

Scratches made by the small fingernails of peers, unlike those from sharp tools or an adult's sharp, large fingernails, are often not deep unless there is a significant intent. Therefore, they naturally tend to have a good prognosis. If you are greatly concerned, you should seek a plastic surgeon experienced not only in the extent of the tear but also in skin grafting (a surgery involving removing and reattaching skin). You will receive a scientific and reliable answer from them more than anyone else.

Frequently Asked Questions

Can scratches from children's fingernails regenerate perfectly without a scar?

No, after birth, perfect regeneration is difficult for tissues other than bone, internal organs, and oral mucous membranes. The skin also heals with scar tissue. However, the extent of the scar can vary depending on the depth of the wound.

Is suturing necessary for deep wounds?

Yes, if a wound is gaping open, it is best to minimize its width and depth as much as possible through suturing. Suturing helps reduce granulation tissue formation, shortens the healing period, and minimizes scar tissue.

What should be checked in the case of a deep wound?

In cases of deep dermal damage, it is essential to check for damage to the functional tissues beneath the dermis and to confirm if foreign bodies have entered under the skin. If foreign bodies are present, they must be removed. If functional tissue damage is severe, it may be difficult to handle at a clinic level.

What is the usual prognosis for children's fingernail scratches?

Scratches caused by the small fingernails of peers are often not deep, so they naturally tend to have a good prognosis. If the depth and extent of the wound are minor, there is a high probability of a small scar remaining.

Can wounds be managed with taping instead of suturing?

Yes, it is possible. For minor wounds with some dermal layer invasion but not overall deep, management can involve applying skin closure tape (Steri-strip) to narrow the width of the wound.