Reconstruction of complex nail matrix defect using the homodigital reverse fasciocutaneous flap

Surgical repair for deformities of the nail unit

The nail apparatus is the largest and most complex skin appendage. Defects in this unit can result in significant functional insufficiency and cosmetic disfigurement. Common nail deformities include split nail, short nail, onycholysis, nail malalignment, hooked nail, and absent nail. Currently, surgical repair is the primary treatment for such deformities. Based on the etiological and anatomical classifications, one or more appropriate operations can be selected to repair nail unit deformities. These include autologous fat grafting, longitudinal cicatrectomy, Z-plasties, nail bed elongation, split-thickness sterile matrix grafting, volar V-Y advanced flap reconstruction, sterile matrix particle grafting, germinal matrix flaps, and germinal matrix grafting. This review discusses the fundamental classification of nail unit deformities, common reconstructive surgical techniques, and their features.

The Clinical Effect of Digital Dorsal Fascial Island Flap Combined With Crossfinger Flap for Repairing Distal Degloving Injury and Sensory Reconstruction

Background

To explore the clinical effect of digital dorsal fascial island flap combined with crossfinger flap to repair distal degloving injury and sensory reconstruction.

Methods

A total of 19 patients with distal fingertip degloving injuries treated with digital dorsal fascial island flap combined with crossfinger flap in our hospital from April 2018 to August 2020 were retrospectively included. Semmes–Weinstein (SW) monofilament and static two-point discrimination (S-2PD) tests, active range-of-motion (ROM) of the fingers, cold intolerance, visual analog scale (VAS) score patient complications, and patient satisfaction were evaluated.

Results

Five cases with post-operative flap blisters were treated at the time of dressing changes until successful scab formation. Three cases with post-operative arterial crisis of finger arterial dorsal branch vessel were relieved after suture removal and tension reduction. All other skin flaps and skin grafts survived. Nineteen patients received follow-up between 3 and 26 months (average 14.6 months). The active ROM of metacarpophalangeal (MCP) and interphalangeal (IP) joints of the injured fingers were satisfactory.

Conclusion

The digital dorsal fascial island flap combined with the crossfinger flap for repairing the distal degloving injury of the distal segment of the finger is a good surgical method, which is simple and easy to operate, can repair a large area of soft tissue defect, and obtain a satisfactory effect.

Flow-through flap with wrist epithelial branch of ulnar artery for repair of finger soft tissue defect: a case series

OBJECTIVE

To evaluate the surgical technique and the efficacy of flow-through flap with a wrist epithelial branch of the ulnar artery to repair a finger soft tissue defect.

METHODS

Between June 2015 and December 2017, 12 cases of soft tissue defects of fingers and injured digital artery were repaired by flow-through flap with wrist epithelial branch of the ulnar artery, including 7 males and 5 females (age range: 18-45 years old, average age: 23.6 years old). The causes of injury included electric saw injury in 7 cases, and machine crush injury in 5 cases. 5 cases were combined with tendon injury, 4 cases with fracture, 12 cases with vessel injury and 2 cases with nerve injury. The area range of the flap was 3.0 cm ×1.8 cm to 6.0 cm ×3.0 cm. The length of the pedicles of the flaps ranged from 2.3 cm to 4.7 cm, with an average length of 3.7 cm. The donor sites were sutured directly in 10 cases, and 2 cases were repaired with a full-thickness skin graft from the ilioinguinal region. Flow-through anastomoses of the distal and proximal end of the wrist epithelial branch of the ulnar artery to the distal and proximal end of the digital artery were created, so as to connect the vessels and reach the physiologic state of blood supply.

RESULTS

All flaps and skin grafts survived after operation, and all wounds healed at I phase. All patients were followed up 6-12 months (mean: 9 months). The flaps exhibited smooth appearance and soft texture, similar to that of the normal surrounding skin. At last follow-up, the two-point distance of flaps was 9-15 mm (mean: 11 mm). According to the assessment of upper limb function issued by the Hand Surgery Society of Chinese Medical Association, the hand function was excellent in 10 cases, and good in 2 cases. The ulnar wrist donor areas only had linear scar.

CONCLUSION

Flow-through flap with wrist epithelial branch of ulnar artery exhibits strength in a concealed donor site, reliable blood supply, and simple operation. Flow-through method can be used to repair a broken or defective digital artery in I stage. It is a good method to repair a soft tissue defect of fingers.

Effect of Health Care and Rehabilitation Nursing and Analysis of Neurovascular Preservation of Patients Undergoing Reconstruction of Severed Finger under X-ray Image Examination

OBJECTIVE

The study aimed to provide a guideline for continuous rehabilitation nursing for patients with severe finger replantation, and establish a satellite contact point for patients with severe finger replantation after discharge, so as to ensure scientific and effective rehabilitation training after discharge and explore the role of continuous rehabilitation nursing measurement in severe finger rehabilitation and neurovascular preservation.

METHODS

A total of 380 patients accepting neurovascular preservation finger replantation in the hand surgery department were divided into an observation group and a control group according to the number of hospitalizations. All patients underwent reconstructive surgery of severed finger. X-ray filming was used to monitor the postoperative nursing effect of neurovascular preservation of severed finger. The discharged patient information questionnaire was filled 3 days before the discharge. Then, a patient information database was established, and rehabilitation training was performed. Finally, sexual rehabilitation nursing follow-up intervention, telephone follow-up, and cross-referring intervention were carried out. Postoperative x-ray images were taken regularly to observe the recovery of reconstructed finger.

RESULTS

There was no difference in daily life ability scores and hand function scores between the 2 groups at discharge (P > 0.05). The daily life ability scores and hand function scores of the observation group were better than those of the control group at 1 and 6 months after discharge (P < 0.05), the difference is statistically significant. As the discharge time prolonged, the daily life ability score and hand function score of the 2 groups of patients gradually increased. X-ray images showed that the replanted finger body was well developed, phalanx was in good antithesis, and there was no epiphysis.

CONCLUSIONS

Continuous rehabilitation nursing measures should be taken after the replantation of the severed finger after neurovascular preservation, which provides standardized rehabilitation training standards for patients with replantation of severed finger after discharge, improves patient training compliance, promotes hand function recovery as soon as possible, and enables patients to return to society as soon as possible, which is worthy of clinical promotion and application.

Nail matrix regenerative engineering: in vitro evaluation of poly(lactide-co-glycolide)/gelatin fibrous substrates

Acute traumatic nail injury treatment repair procedures are commonly conducted in emergency departments and primary care offices. Current repair methods use nail splints that are inserted within the nail root to prevent the fusion of the proximal nail fold and the matrix tissue. Splints provide a protective barrier overlying the nail bed soft tissue during recovery periods, but uncertain prognoses (i.e., aesthetic and functional disadvantages) reveal a need for improved nail repair techniques. Nail splints are not specifically designed for nail organ restoration via biological mechanisms, thus, a clinical application that utilizes regenerative engineering techniques can prove useful in improving the nail injury prognoses. Using the coaxial electrospinning method, hybrid poly(lactide-co-glycolide) (PLGA) (85:15) and gelatin fibrous scaffolds (Hybrid_1: PLGA shell, gelatin core and Hybrid₂ : gelatin shell, PLGA core) with average fiber diameters of 540 ± 118 and 2,215 ± 1,135 nm, respectively, were produced and successful encapsulation of core fibers was observed. Furthermore, nail stem cells expressing stem cell characteristic markers CD90, CD29, and Lgr6 showed preferred attachment to Hybrid₂ scaffolds after 24 hr. Overall, an in vitro regenerative engineered nail matrix may aid to improve the cosmetic appearance and function of injured nail organs post-traumatic injury.