Free vascularized nail grafts

A considerable amount of literature has been written on microneurovascular surgery for the reconstruction of partial defects in fingers, but little has been published on reconstruction to replace lost fingernails. We report on two clinical cases in which a free vascularized nail graft and a “double onychocutaneous flap” were used successfully. We suggest that the free vascularized nail graft is a superiormethod in reconstruction to treat fingernail loss or deformity.     

Free skin grafting

Our interpretation of fundamental factors involved in free skin grafting have been presented with the aim of extending the usefulness of this simple operative procedure. These fundamental factors involve theoretic and factual considerations of epithelial and secondary tissues.The epithelial and cardiac tissues we believe are the most important fundamental tissues in the body; the epithelial tissues keep us wet animals, the cardiac tissues circulate this wetness. Barring specific disease, these tissues will survive at the expense of all other tissues in order to serve the body and work for body needs until the last remote chance of repair is gone.We make use of the vital characteristics of the type of epithelium we are dealing with, the epidermis (ectodermal epithelium), in determining the time to operate, our operative procedure and postoperative care.The time to perform a free skin graft operation is when the patient can withstand a simple operation; we are not concerned with the ability of the epidermis to survive. It will survive if applied to a suitable base properly and at the expense of the body if need be. Establishing a minimum of body economy as to blood count, hemoglobin, etc., leads to needless delay in free skin grafting. Loss of vital fluid incident to this delay causes degenerative processes in vital organs. The plane of body efficiency is lowered and the patient reverts to the picture of starvation.We classify granulation tissue in the category of free skin grafting as useful, useless and pernicious. It is useful in the first stages of its appearance when the collagenous tissue base is minimal; useless at a later date because a better base can be obtained if the granulation and collagenous tissues are removed; pernicious still later because the healthy appearance of the firm, flat granulations belie the thick layer of strangling collagenous tissue beneath. The reason why the granulations are firm and flat is because the collagenous tissue is at a late stage of maturity, the bed is strong and firm and the capillaries are partly occluded by organizing immature scar.The epidermis has no direct blood supply. It lives on overflowing springs of tissue fluid. This fluid filters through a delicate white fibrous tissue feltwork of the dermis to the epidermis. Our operative procedure is designed to provide optimum conditions for the body to reconstruct from secondary tissue something similar to this fine feltwork which has been lost.For this reason the firm, heavy blanket of secondary tissue found lying on the major supply of necessary nutrition is removed. This allows the body to reconstruct something of secondary tissue, more in keeping with the missing, delicate veil of primary tissue.We believe that success in free skin grafting depends upon the internal fixation of the graft to the host by a physiologic glue, the clot. We do not believe that it depends upon the external pressure of bandages in an attempt to achieve the same result.General, special, local and refrigeration anesthesia are used. As to thermal anesthesia, we follow the method suggested to Dr. Eastman Sheehan and ourselves by Dr. Frederick Allen, i. e., to apply ice bags continuously for two hours prior to operation over the donor site and the area to be skin grafted.We have not been able to sterilize granulating areas surgically by any means other than by their total destruction with a corrosive agent. Since we do not use granulation tissue for skin grafting, its loss is of no moment.Donor sites are unbandaged except for a single layer of gauze which is placed over the wound.Postoperative care, except for general supportive measures, is confined to means of protecting the grafts. A variety of methods may be used.     

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.     

断层甲床移植治疗甲床缺损

目的：研究断层甲床移植治疗甲床缺损的临床效果。方法对2004年2月-2005年1月收治的8例甲床缺损患者进行断层甲床移植手术,并进行术后随访。结果除1例出现甲畸形,2例伴有渗液外,其余病例均恢复正常。结论对不伴有生发基质损伤的甲床缺损,断层甲床移植术具有很好的疗效,且简便易行,适于推广。     

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.     

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.     

Tibio-talo-calaneal arthrodesis by retrograde intramedullary nail and bone grafting

Tibio-talo-calcaneal fusion is a salvage procedure for severe ankle and hind foot arthrosis with deformity. There are numerous techniques described in the literature but no uniformly accepted method. We conducted a retrospective study of 40 patients who underwent 43 tibio-talo-calcaneal fusions with a retrograde intramedullary nail and bone grafting. The average age was 52 years. The average follow up was 34 months. Patients were assessed clinically; radio logically, the AOFAS score and patient satisfaction. Solid fusion was achieved in 37 cases. Post-operative AOFAS score showed improvement in pain and function. The procedure was associated with high complications and morbidity including one below knee amputation. We conclude that tibio-talo-calcaneal fusions with retrograde nailing and bone grafting is a successful salvage procedure in these advanced cases to improve pain and function.     

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.