[Treatment of post-traumatic nail bed deformities with split-thickness nail bed grafts]

Clinical outcomes of reposition flap transfer for fingertip amputation

PURPOSE

This study aimed to describe the reposition flap for reconstructing fingertip amputation when replantation is not possible.

METHODS

This study retrospectively reviewed the records of patients with reposition flap transfers and investigated postoperative clinical outcomes and patient satisfaction. Sixteen patients with fingertip amputations treated with a reposition flap from 2016 to 2020. The mean age at injury was 46 years (range, 26-70 years). Ten cases were treated with oblique triangular advancement flaps, 3 with retrograde-flow digital artery flaps, and 3 with thumb palmar advancement flaps. Postoperative outcomes, including wound healing period and the IP/PIP extension angle, and the presence of grafted bone absorption and patient satisfaction were evaluated as of 3 years after surgery.

RESULTS

The average reduction in passive extension angle of the IP/PIP joint was 19°. The average time for complete wound healing was 28 days (range, 18-41 days). The reduction in passive extension angle of the IP/PIP joint was significantly correlated with the wound healing period (r = 0.66, p = 0.01). The absorption of the grafted bone was observed in 3 cases. In these cases, the distal tip of the flap became thin due to flap retraction and an insufficient flap volume. All patients were highly or fairly satisfied with the results of surgery.

CONCLUSION

Our findings show that IP/PIP flexion contracture can occur due to delayed wound healing after reposition flap transfer, but the patient satisfaction level was generally high. Therefore, reconstruction using a reposition flap gives acceptable clinical outcomes and high patient satisfaction as a result of medium to long-term.

Physiology of the nail apparatus: Surgical consequences

Knowledge of nail physiology is mandatory to understand nail pathologies, and to know what to repair and what to expect from your repair. Unfortunately, nail physiology in humans is not completely understood. However, there are some data that have been validated and must be known before treating patients. The nail plate is mostly made of keratins. It is produced solely by the nail matrix. The nail bed is mostly responsible for nail pate adhesion. At the hyponychium, the plate loses its adherence. The hyponychium is the first barrier of defense preventing bacteria and fungi from invading the subungual area. All these structures, along with the nail folds, are responsible for the orientation of nail-plate growth. However, many questions, such as whether to replace the nail plate at end of procedure, remain open.

Trauma to the nail complex

OBJECTIVE

to analyze the results from surgical intervention to treat trauma of the nail complex.

METHODS

we retrospectively reviewed a series of 94 consecutive patients with trauma of the nail complex who were treated between 2000 and 2009. In 42 patients, nail bed suturing was performed. In 27 patients, nail bed suturing was performed subsequent to osteosynthesis of the distal phalanx. In 15, immediate grafting was performed, and in 10, late-stage grafting of the nail bed. The growth, size and shape of the nail were evaluated in comparison with the contralateral finger. The results were obtained by summing scores and classifying them as good, fair or poor.

RESULTS

the results were considered to be good particularly in the patients who underwent nail bed suturing or nail bed suturing with osteosynthesis of the distal phalanx. Patients who underwent immediate or late-stage nail grafting had poor results.

CONCLUSION

trauma of the nail complex without loss of substance presented better results than did deferred treatment for reconstruction of the nail complex.

Distal replantation, nail bed, and nail problems in musicians

Nails enhance pulp sensibility, increase pulp stability and are necessary for fine prehension. A finger without a nail will compromise a musician's career if the finger involved is necessary to play a note (strings, keyboards) or hold a position (winds). Salvage of the nail is then a very important part of any surgical procedure in musicians with distal finger trauma. Surgical techniques will depend on the level and type of nail injury. Replantation is by far the best technique in distal finger amputation but, when not feasible, reposition-flap repair may be used. In isolated nail lesions, sutures, split-thickness nail bed graft, or nail matrix flaps are used according to the level and severity of the lesion.