Fingertip reconstruction by nail bed grafting using thenar flap

Ideally, treatment for fingertip injury should involve the least pain possible, using durable and sensate skin with due consideration to aesthetic aspects. This paper presents two cases of fingertip reconstruction through the use of thenar flaps and nail bed grafts. In either case, injury had been due to fingertip crushing and reconstruction was conducted immediately thereafter. A full-thickness nail bed with hyponychium and perionychium from the severed part was used for dorsal reconstruction and thenar flaps for finger pulp reconstruction. In both cases, the grafting was quite satisfactory and good soft-tissue healing was observed. Subsequent nail growth and adherence were good. The outcome was pleasing to both patients. Thus, the presented method may be considered quite satisfactory from aesthetic and functional recovery standpoints.     

Free nail bed graft for treatment of nail bed injuries of the hand

Free full-thickness grafts of nail bed of the lesser toes or an amputated fingertip were successfully performed on 11 fingers of 10 patients since 1979. In nine patients in whom the nail beds had been severely crushed or lost, but the nail matrix was intact, the end results of this technique were excellent. In one patient in whom both the nail bed and matrix had been lost, free grafting of the toenail bed and matrix was performed, with a good result. The procedure can be used when restoring the length of the tip in fingertip amputation if used in combination with local skin flaps such as V-Y advancement or local rotation flaps.     

手指指甲缺损的单全趾甲复合组织移植再造术

目的对手指指甲缺损或畸形进行重建，再造理想的指甲。方法以携带最小量组织进行切取包括趾甲、甲下皮、甲周膜在内的复合组织及其营养动脉、静脉和神经，与受区进行趾-指动脉、静脉、神经的吻合，完成单一全趾甲复合组织移植再造指甲。结果再造9例13指，术后均顺利成活，外形满意，接近原手指指甲的效果，供区的外观和功能无明显影响。结论应用显微外科技术，可使手指甲再造等手外科手术做的更精细，治疗效果更理想。     

Results of vertical figure-of-eight tension band suture for finger nail disruptions with fractures of distal phalanx

Background:

Fingertip injuries involve varying degree of fractures of the distal phalanx and nail bed or nail plate disruptions. The treatment modalities recommended for these injuries include fracture fixation with K-wire and meticulous repair of nail bed after nail removal and later repositioning of nail or stent substitute into the nail fold by various methods. This study was undertaken to evaluate the functional outcome of vertical figure-of-eight tension band suture for finger nail disruptions with fractures of distal phalanx.

Materials and Methods:

A series of 40 patients aged between 4 and 58 years, with 43 fingernail disruptions and fracture of distal phalanges, were treated with vertical figure-of-eight tension band sutures without formal fixation of fracture fragments and the results were reviewed. In this method, the injuries were treated by thoroughly cleaning the wound, reducing the fracture fragments, anatomical replacement of nail plate, and securing it by vertical figure-of-eight tension band suture.

Results:

All patients were followed up for a minimum of 3 months. The clinical evaluation of the patients was based on radiological fracture union and painless pinch to determine fingertip stability. Every single fracture united and every fingertip was clinically stable at the time of final followup. We also evaluated our results based on visual analogue scale for pain and range of motion of distal interphalangeal joint. Two sutures had to be revised due to over tensioning and subsequent vascular compromise within minutes of repair; however, this did not affect the final outcome.

Conclusion:

This technique is simple, secure, and easily reproducible. It neither requires formal repair of injured nail bed structures nor fixation of distal phalangeal fracture and results in uncomplicated reformation of nail plate and uneventful healing of distal phalangeal fractures.     

Nail Unit Matrix Transplantation: A Plastic Surgeon''s Approach

The growth of the nail is primarily from the nail bed and mostly from the germinal matrix component, and to some extent from the sterile matrix as well. The purpose of this article is to describe the approach and technique of a composite nail, nail bed, hyponychium, and perionychium transplant when the total nail and nail bed need reconstruction. A case is presented when a nail bed junctional nevus is excised and reconstruction with nail unit matrix transplantation and the result is shown.     

应用第二套供血系统的全指甲再造术

目的探讨对手指指甲缺损或畸形进行精细重建的技术。方法对2003年12月-2004年6月在我院应用显微外科技术治疗的9例指甲（13指）缺损患者进行回顾性分析。所有患者均利用第二套供血系统以携带最小量组织进行切取包括趾甲、甲床、甲下皮、甲周膜在内的复合组织及其营养动脉、静脉和神经，与受区进行趾-指动脉、静脉、神经的吻合，完成单一全趾甲复合组织移植再造指甲。结果所有再造指甲均顺利成活，外形十分满意，接近原手指指甲的效果，供区的外观和功能无明显影响。结论应用第二套供血系统的全指甲单位再造术，可获得理想的治疗效果。     

Reconstruction of finger tip amputations with advancement flap and free nail bed graft

Fifteen finger tip amputations through the proximal half of the nail bed were reconstructed with palmar V-Y advancement flaps and full thickness nail bed grafts. The undersurface of the V-Y flap was sutured to the nail bed remnant and the raw area was covered with full thickness nail bed grafts from the amputated part. They were followed for a minimum period of one year and the nail bed grafts took fully in all patients. The results were best in the thumb and least favourable in the little finger but all the patients were happy with the cosmetic result and the functional outcome. This technique results in an average gain of 5 mm of extra length to the nail. This is a useful technique when replantation of a distal fingertip amputation is not possible.     

Emmert-plasty for ingrown toe nail

Surgical Principles Excision of the involved quarter of the toe nail. Wedge excision of nail fold, nail bed and nail matrix down to the bone of the terminal phalanx of the toe [4, 6]. In cases without inflammation: wedge excision of involved nail fold. Revised Version from: Operat. Orthop. Traumatol. 2 (1990), 39–45 (German Edition).     

A new surgical technique for the correction of pincer nail deformity

BACKGROUND: Pincer nail is a rare deformity characterized by transverse overcurvature of the nail that increases distally. Many conservative and surgical treatment modalities have been recommended, but there is not a worldwide accepted technique for long lasting treatment of this deformity yet. PURPOSE: A new surgical technique for the treatment of pincer nail deformity is described. MATERIAL AND METHOD: In this procedure, after the osteophyte located on the dorsal surface of the distal phalanx is removed to provide a flat surface for the nail bed, the distal part of the nail bed is enlarged in a transverse direction by using a modified 5-flap z-plasty technique. Over 2 years, this technique has been performed on 15 toes in 8 patients. RESULTS: In all patients, the deformity was eliminated successfully with no recurrence in 2 years of follow up. The growing nail turned back into its natural form and all clinical signs and symptoms of the pincer nail deformity were relieved. CONCLUSIONS: Widening and flattening the nail bed provide a longlasting effective treatment of the pincer nail deformity with an excellent esthetic result. Pain and episodes of infection is relieved perfectly with this new technique.     

顺行岛状皮瓣与甲床回植术治疗指尖离断伤

目的探讨急诊采用顺行岛状皮瓣与甲床回植治疗指尖离断伤的显微修复方法。方法对10例指尖离断伤的患者,急诊采用顺行岛状皮瓣与甲床回植进行显微修复。指尖离断平面分别位于甲中及甲根部平面。结果术后10例皮瓣和回植甲床均全部存活,术后随访时间为6～12个月。指端外观满意,皮瓣质地柔软,手指无明显触痛,活动功能正常。术后指甲较术前平均延长4．0～6．0mm,其中指甲与甲床完全附着8例,4／5附着2例。9例指甲光滑、无压痛,1例出现钩甲畸形。结论对甲根以远指尖离断无再植条件者,采用顺行岛状皮瓣修复手指残端,可保留手指的长度;将游离甲床回植,并加压包扎,可修复部分甲床,改善手指远端的外形。     

微粒甲床组织移植治疗甲床缺损

目的 探讨利用伤指剩余甲床微粒移植治疗甲床缺损.方法 对16例18指甲床缺损的患者,片状切取伤指的剩余甲床,将其切成微粒状的均匀组织植于甲床缺损处,打包加压包扎,术后2周拆线.结果 本组16例18指术后微粒甲床移植均Ⅰ期成活,其中2指中心部缺损遗留小部分指骨外露,经换药后愈合.术后随访时间为8～21个月,18指中达到优良16指(占88.9%),差2指(占11.1%).结论 微粒甲床移植解决了甲床缺损的修复材料问题.方法简单,效果理想,易于推广.     

微粒甲床组织移植治疗甲床缺损

目的 探讨利用伤指剩余甲床微粒移植治疗甲床缺损.方法 对16例18指甲床缺损的患者,片状切取伤指的剩余甲床,将其切成微粒状的均匀组织植于甲床缺损处,打包加压包扎,术后2周拆线.结果 本组16例18指术后微粒甲床移植均Ⅰ期成活,其中2指中心部缺损遗留小部分指骨外露,经换药后愈合.术后随访时间为8～21个月,18指中达到优良16指(占88.9%),差2指(占11.1%).结论 微粒甲床移植解决了甲床缺损的修复材料问题.方法简单,效果理想,易于推广.     

微粒甲床组织移植治疗甲床缺损

目的 探讨利用伤指剩余甲床微粒移植治疗甲床缺损.方法 对16例18指甲床缺损的患者,片状切取伤指的剩余甲床,将其切成微粒状的均匀组织植于甲床缺损处,打包加压包扎,术后2周拆线.结果 本组16例18指术后微粒甲床移植均Ⅰ期成活,其中2指中心部缺损遗留小部分指骨外露,经换药后愈合.术后随访时间为8～21个月,18指中达到优良16指(占88.9%),差2指(占11.1%).结论 微粒甲床移植解决了甲床缺损的修复材料问题.方法简单,效果理想,易于推广.     

微粒甲床组织移植治疗甲床缺损

目的 探讨利用伤指剩余甲床微粒移植治疗甲床缺损.方法 对16例18指甲床缺损的患者,片状切取伤指的剩余甲床,将其切成微粒状的均匀组织植于甲床缺损处,打包加压包扎,术后2周拆线.结果 本组16例18指术后微粒甲床移植均Ⅰ期成活,其中2指中心部缺损遗留小部分指骨外露,经换药后愈合.术后随访时间为8～21个月,18指中达到优良16指(占88.9%),差2指(占11.1%).结论 微粒甲床移植解决了甲床缺损的修复材料问题.方法简单,效果理想,易于推广.     

微粒甲床组织移植治疗甲床缺损

目的 探讨利用伤指剩余甲床微粒移植治疗甲床缺损.方法 对16例18指甲床缺损的患者,片状切取伤指的剩余甲床,将其切成微粒状的均匀组织植于甲床缺损处,打包加压包扎,术后2周拆线.结果 本组16例18指术后微粒甲床移植均Ⅰ期成活,其中2指中心部缺损遗留小部分指骨外露,经换药后愈合.术后随访时间为8～21个月,18指中达到优良16指(占88.9%),差2指(占11.1%).结论 微粒甲床移植解决了甲床缺损的修复材料问题.方法简单,效果理想,易于推广.     

微粒甲床组织移植治疗甲床缺损

目的 探讨利用伤指剩余甲床微粒移植治疗甲床缺损.方法 对16例18指甲床缺损的患者,片状切取伤指的剩余甲床,将其切成微粒状的均匀组织植于甲床缺损处,打包加压包扎,术后2周拆线.结果 本组16例18指术后微粒甲床移植均Ⅰ期成活,其中2指中心部缺损遗留小部分指骨外露,经换药后愈合.术后随访时间为8～21个月,18指中达到优良16指(占88.9%),差2指(占11.1%).结论 微粒甲床移植解决了甲床缺损的修复材料问题.方法简单,效果理想,易于推广.     

微粒甲床组织移植治疗甲床缺损

目的 探讨利用伤指剩余甲床微粒移植治疗甲床缺损.方法 对16例18指甲床缺损的患者,片状切取伤指的剩余甲床,将其切成微粒状的均匀组织植于甲床缺损处,打包加压包扎,术后2周拆线.结果 本组16例18指术后微粒甲床移植均Ⅰ期成活,其中2指中心部缺损遗留小部分指骨外露,经换药后愈合.术后随访时间为8～21个月,18指中达到优良16指(占88.9%),差2指(占11.1%).结论 微粒甲床移植解决了甲床缺损的修复材料问题.方法简单,效果理想,易于推广.     

微粒甲床组织移植治疗甲床缺损

目的 探讨利用伤指剩余甲床微粒移植治疗甲床缺损.方法 对16例18指甲床缺损的患者,片状切取伤指的剩余甲床,将其切成微粒状的均匀组织植于甲床缺损处,打包加压包扎,术后2周拆线.结果 本组16例18指术后微粒甲床移植均Ⅰ期成活,其中2指中心部缺损遗留小部分指骨外露,经换药后愈合.术后随访时间为8～21个月,18指中达到优良16指(占88.9%),差2指(占11.1%).结论 微粒甲床移植解决了甲床缺损的修复材料问题.方法简单,效果理想,易于推广.     

微粒甲床组织移植治疗甲床缺损

目的 探讨利用伤指剩余甲床微粒移植治疗甲床缺损.方法 对16例18指甲床缺损的患者,片状切取伤指的剩余甲床,将其切成微粒状的均匀组织植于甲床缺损处,打包加压包扎,术后2周拆线.结果 本组16例18指术后微粒甲床移植均Ⅰ期成活,其中2指中心部缺损遗留小部分指骨外露,经换药后愈合.术后随访时间为8～21个月,18指中达到优良16指(占88.9%),差2指(占11.1%).结论 微粒甲床移植解决了甲床缺损的修复材料问题.方法简单,效果理想,易于推广.     

微粒甲床组织移植治疗甲床缺损

目的 探讨利用伤指剩余甲床微粒移植治疗甲床缺损.方法 对16例18指甲床缺损的患者,片状切取伤指的剩余甲床,将其切成微粒状的均匀组织植于甲床缺损处,打包加压包扎,术后2周拆线.结果 本组16例18指术后微粒甲床移植均Ⅰ期成活,其中2指中心部缺损遗留小部分指骨外露,经换药后愈合.术后随访时间为8～21个月,18指中达到优良16指(占88.9%),差2指(占11.1%).结论 微粒甲床移植解决了甲床缺损的修复材料问题.方法简单,效果理想,易于推广.