Nail Regeneration by Elongation of the Partially Destroyed Nail Bed:

Denis-Katz HN, Knox AD. Nail Bed Regeneration by Excision of Distal Scarred Matrix in a Patient with Porphyria Cutanea Tarda

Onycholysis secondary to nail bed scarring can be a challenging problem for hand surgeons, given the relatively few techniques available for nail bed lengthening. Here, we present the case of a patient with upper extremity onycholysis, secondary to porphyria cutanea tarda. We used a technique first described by Lemperle et al in 2003 to successfully lengthen the nail bed and improve the appearance of the nail plate. This involved full-thickness excision of a crescent-shaped wedge of the distal nail bed in all five right sided digits in a single operation. We found this technique to be simple and effective, meeting our patient's goals after just one excision.

Nail dystrophy for the surgeon

Injuries to the fingertips are the most frequently occurring damage to the hand. The nail is an exceptional structure within the human body that offers both stability and protection, as well as the ability to perform fine and precise movements. Nail dystrophies are numerous, post-traumatic, post-infection or even degenerative. They raise many difficulties for the treating hand surgeon. Which anatomical structure is dystrophic? Is there any secondary fungal superinfection to be treated before surgery? Among the various techniques proposed, which one will help to improve my patient as a complete cure is rarer than partial failures. In this chapter we have chosen to describe the surgical techniques, their difficulties and drawbacks, that are available for the most frequent dystrophies that the hand surgeons may treat.

Does the Nail Bed Regenerate?

BACKGROUND

The regenerative potential of the nail bed after trauma remains controversial.

METHODS

We performed a retrospective review of 51 patients who underwent nail bed reconstruction with 2 techniques (direct flow island flap or a Tranquilli-Leali "Atasoy" flap) due to trauma involving the nail bed complex. These 2 flaps were used to support the loss of distal substance and to allow the regeneration of the nail bed. Outcomes were analyzed for at least 18 months. There were 34 men (66.7%), and the average age was 16.1 years. Most patients (56.9%) had crush injuries. The little (16) and index (14) fingers were the most affected. Twenty-seven were children (range: 4-11) with an average age of 7.4 ± 1.9 years. The middle finger was the most affected (29.2%).

RESULTS

The outcomes were good to excellent in 41 operated patients (80.4%). Hook nail was absent in 84.3% of the patients. Most patients (98%) did not develop necrosis. Children had an excellent/good outcome rate of 85.2%, while in adults, the rate was 75% of cases (P = .485).

CONCLUSION

The direct flow island flap is superior in terms of outcome, regardless of age, sex, affected finger, dominant hand, type of trauma, and injury zone. In cases where there was a correct reconstruction of the hyponychium, there was regeneration of the nail bed.

Disappearing Nail Bed: Review of Etiology, Grading System, and Treatment Options

Disappearing nail bed (DNB) is a condition characterized by irreversible epithelialization of the nail bed following long-standing onycholysis. This phenomenon can occur in fingernails and toenails. Factors implicated in the development of DNB include trauma, manicuring, and onychotillomania and dermatologic conditions like psoriasis and dermatitis. Specifically for the toenail, contributing factors also include increasing age, history of trauma, surgery, onychomycosis, and onychogryphosis. A grading system that stages the progression of onycholysis to DNB has been proposed to aid clinicians in the diagnosis and treatment of these conditions. Several methods have been designated for the treatment of DNB.

IFSSH scientific committee on skin coverage: 2015 report

Skin coverage in hand reconstruction is a challenging and vast chapter in hand surgery; covering every aspect of it in a report is simply not feasible. Therefore, this report focuses on a few specific topics. The coverage of anatomical regions like the fingertips is common ground for hand surgeons worldwide, but in the last 10 years, various refinements have been published in order to optimize the reconstruction of this organ. Nevertheless, in many emergency departments, the amputation of badly injured fingertips, including the thumb, remains the preferred treatment. The main focus of this report is to counter this tendency by providing alternatives to surgeons. Large defects in the fingers involving more than one segment, defects in the palm and in the dorsum of the hand are currently debated in international meetings. The use of skin substitutes vs. the use of extremely refined microsurgical procedures vs. classic island flaps has generated animated discussions, which are also influenced by cultural and socioeconomic factors around the world. This report offers the views of six surgeons from four different countries, in the hope of animating discussions and suggesting new approaches.

Cessation of nail growth following Bajiaolian intoxication

Bajiaolian (Dysosma pleianthum), a species in the Mayapple family (Podophyllum pelatum), has been widely used as a traditional Chinese herbal medication for the remedies of snake bite, tumor growth, post-partum recovery, and acne. It has also been used in western medicine, especially topically for various skin lesions. Both oral ingestion and dermal application may result in severe toxicity. The clinical presentations reported after Bajiaolian poisoning include nausea, vomiting, diarrhea, abdominal cramps, tachycardia, orthostatic hypotension, paralytic ileus, urinary retention, hepatorenal dysfunction, leukocytosis followed by leukopenia, thrombocytopenia, prolonged areflexia, prolonged paraethesia and sensory ataxia, dizziness, fever, memory impairment, hallucinations, paranoia, convulsion, fainting, and coma. There are no previous reports in the literature about the cessation of nail growth as a clinical presentation following Bajiaolian poisoning. We present a case of nail growth that was halted for more than seven years after a single case of Bajiaolian poisoning.

Fingertip injuries

Fingertip injuries are a potential cause of significant morbidity within the workplace and the community. Although they account for a low proportion of ED presentations, importantly they can frequently be managed entirely by emergency staff. A literature review was undertaken to identify the epidemiology, the assessment process and the management options for fingertip injuries as relevant to emergency medicine.