Combined Nail Reconstruction of the Fingertip Amputation
Keywords:
fingertip amputation, local flap, nail reconstructionAbstract
Objective: The objective of this study is to analyze the aesthetic and functional results of a technique for nail salvage by eponychial folding combined with several techniques of local flap coverage to remedy the pulp and increment exposed nail matrix at the same time after fingertip amputation.
Methods: In the period between January 2018 and February 2019 at Samutsakorn Hospital, thirty cases of fingertip amputation with nail bed defects underwent pulp reconstruction with different local flaps depending on the injury deformity. We increased nail bed exposure by creating 4-6 mm parallel incision at distal eponychium. The eponychium flap was elevated then fold proximally to expose more nail matrix, thereby effectively lengthening the exposed nail bed. The outcomes for fingertip appearance, nail length, and nail bed area at pre and postoperative treatment were evaluated. The fingers’ range of motion (ROM) and tip pinch force were compared to the contralateral uninjured fingers’ as control. The paired t test was employed for α<.05 considered statistically significant.
Results: There were 25 patients (5 patients were affected 2 fingers) with mean age of 31
(18-51 years). The procedures were performed averagely at 6 hours (3-24) after injury, neither
pulp reconstruction nor eponychial flap loss occurred. The visible nail increased 5.78 mm
(4-7mm), nail bed area was enlarged 60% (35-150%) . All patients were satisfied with the appearance and function of the reconstructed fingertips.
Conclusions: Fingertip amputation with nail bed involvement should be reconstructed
not only volar soft tissue, but considered the nail as well. Eponychial folding combined with
different local flaps provided for the aesthetic and functional restoration of the fingertip
amputation with nail defect.
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ลิขสิทธิ์บทความเป็นของผู้เขียนบทความ แต่หากผลงานของท่านได้รับการพิจารณาตีพิมพ์ลงวารสารแพทย์เขต 4-5 จะคงไว้ซึ่งสิทธิ์ในการตีพิมพ์ครั้งแรกด้วยเหตุที่บทความจะปรากฎในวารสารที่เข้าถึงได้ จึงอนุญาตให้นำบทความในวารสารไปใช้ประโยชน์ได้ในเชิงวิชาการโดยจำเป็นต้องมีการอ้างอิงถึงชื่อวารสารอย่างถูกต้อง แต่ไม่อนุญาตให้นำไปใช้ในเชิงพาณิชย์
