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.     

Squamous cell carcinoma of the nail bed.

Twenty-seven cases of squamous cell carcinoma of the nail bed seen by the author have been reviewed. Sixteen were thought to be primary tumors and eleven to be secondary to chronic exposure to radiation. All had been present for a long time prior to definitive treatment. The tumor was of low grade malignancy with a tendency to invade the distal phalanx. No metastases have been found. Treatment was amputation of the distal phalanx and involved tissues.     

Treatment of post-traumatic nail bed deformities with split-thickness nail bed grafts

INTRODUCTION: Split-thickness nail bed graft have been proposed for treatment of post-traumatic nail bed dystrophies. Only three papers reported good results in 60 to 90% of cases. We report our experience. MATERIAL AND METHODS: We reviewed 18 cases of split-thickness nail bed grafts from operative and consultation files and photographs. Evaluation was made using criteria as the nail plate shape, its adhesion on the nail bed, patient satisfaction and possible sequelae on the donor finger. RESULTANTS: Thirteen patients have been reviewed with a sufficient follow-up to assess the results. In 13 cases, the graft was taken from the hallux. The nail-bed graft was used for hallux reconstruction two times, the thumb six times, index six times, middle and ring finger one each, and the little finger two times. In every patient the graft was molded using either the patient nail or the nail plate from the donor finger. Clinical results were excellent in five cases, good in three and poor in five cases. Five failures were due to wrong indications in three cases in which matrix problem has been underestimated, and infectious failures in two cases. Fifteen per cent of our patients had some sequelae on the donor finger.     

Tumors of the nail and nail bed

This article reviews the tumors that most frequently affect the nail and nail bed. Clinical appearance, histopathology, differential diagnosis, and treatment are discussed.     

Avulsion injuries of the nail bed do not need nail bed graft

From 1985 to 1992, 12 cases of severe avulsion injuries of the nail bed were treated by allowing the nail bed to regenerate naturally, without a nail bed graft irrespective of the extent of nail bed loss. This involved simply covering the residual nail bed with the nail splint for a period of approximately 6 weeks or until the nail bed was observed to be fully regenerated. The patients were then followed up until full nail growth. It was observed that the nail bed regenerated spontaneously, followed by a normal nail growth identical to the contralateral uninjured nail.Proper coverage of the nail bed protected the culture milieu conducive to natural nail bed regeneration, and nail bed grafting was not necessary irrespective of the extent of tissue loss.     

Acute nail bed injuries

Although many consider the fingertip injury a very mundane and simple problem, the mismanagement of this injury can often lead to a chronic esthetic and possibly painful deformity. As noted in this article, the appropriate understanding of the involved structures of a fingertip injury as well as the meticulous management of these injuries can generally lead to a very esthetic and functional fingertip. As previously noted by Elvin Zook, there is probably nowhere that Meskimen's Law, "There is never time to do it right but there is always time to do it over," is more true.     

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。     

An unusual nail bed condition

Subungual squamous cell carcinoma is a misleading condition, occurring mostly in elderly men. The carcinoma is often present for years, once the diagnosis is made. Amputation of a part of the involved digit is still the standard therapy. The reported case points out that biopsy and histological analysis can provide valuable information on the nail bed condition. Age and gender of the patient should not exclude the possibility of a malignancy.     

半层甲床瓣局部转移修复甲床部分缺损

目的探讨应用半层甲床瓣局部转移一期修复甲床部分缺损,并综合评价其功能恢复情况。方法2009年4月～2011年4月,对外伤引起的38例38指甲床部分或大部分缺损病例,采用半层甲床瓣局部转移修复甲床缺损。结果术后随访5-24个月,以最后1次结果进行评估。38例患指外形及功能恢复较满意。结论半层甲床瓣局部转移修复甲床部分缺损手术操作简单,指甲生长良好,效果满意,是治疗外伤性甲床部分缺损的有效方法。     

甲床断层移植一期修复甲床缺损的疗效观察

目的探讨甲床断层移植一期修复甲床缺损的治疗方法,综合评价其功能恢复情况。方法2000年2月至2003年12月,对26例33指甲床部分或大部分缺损病例进行治疗,男21例24指,女5例9指;年龄18～39岁,平均26.5岁;左手17例20指,右手9例13指;拇指7指,示指13指,中指9指,环指4指。均采用同指残留甲床或第一、二、三足趾中厚断层甲床移植方法修复。甲床缺损≥5mm但小于同指甲床面积的1/3时,在指根麻醉或臂丛麻醉下,上指根橡皮止血带,切取同指中厚断层甲片进行移植。甲床缺损大于同指甲床面积的1/3至甲后皱襞以远甲床全部缺损或同时合并两指甲床缺损时,供指采用趾神经阻滞麻醉,趾根橡皮止血带下,切取第一、二、三足趾断层甲片进行移植。结果所有患者均获得随访,随访时间6～30个月,平均17个月。无一例患者发生感染,移植全部成活,指甲生长平整无明显畸形,无疼痛,甲板被覆恢复时间短。术后根据吕桂欣等方法进行疗效评定,优良23例29指,占87.9%;差3例4指,占12.1%。结论甲床缺损中厚断层甲床移植方法操作简单,指甲生长外形良好,畸形发生率低。     

断层甲床游离移植一期修复手指甲床缺损的临床研究

目的 甲床与甲板的生长来源及组织学特征,探讨断层甲床游离移植一期修复手指甲床缺损的治疗方法的可行性、安全性,综合评价术后手指功能情况.方法 通过考证甲床与甲板的基础研究方面的进展,总结我院于2003年8月～2005年8月临床应用第一足趾断层甲床游离移植治疗外伤性甲床缺损15例20指.结果 所有患者均获得随访,随访时间7～26个月,移植甲床全部成活,甲板生长平整无明显畸形,对指端软组织保护、防止指腹软组织向背侧旋转作用明显,同时保留甲板对手指的修饰作用.结论 断层甲床游离移植符合甲床与甲体生长及生发规律,甲板外形良好,尽可能的保留了甲板基本功能,手术方法操作简单,适合在基层医院开展.     

应用伤指残存的邮票样断层甲床移植一期修复甲床缺损

目的探讨利用伤指健存甲床的邮票样断层移植一期修复甲床缺损的临床疗效。方法对18例21指甲床缺损面积40％－80％的患者,采用在伤指健存甲床上切取中厚断层甲片,于手术放大镜下分割成2．0mm×2．0mm的小甲片若干．将其以1～2mm的间隔邮票样植皮均匀平整覆盖至甲床缺损区修复甲床缺损．术后打包加压固定．2周拆线。结果2指术后拆线时出现移植甲床的点状坏死,经换药后愈合;余19指移植甲床均一期成活。术后16例18指随访10-24个月,根据吕桂欣等方法进行疗效评定,优12指,良3指,差3指,优良率83．3％。结论利用伤指健存甲床的邮票样断层移植一期修复甲床的大部分缺损,手术操作简单,易于推广。     

Nail bed reconstruction with split-thickness nail bed grafts.

The results of reconstruction of chronic post-traumatic nail deformities are thought to be unpredictable. We have reviewed eight patients treated by split-thickness nail bed grafts for deformities arising from defects in the sterile matrix. Appearance, adherence and function were improved in all cases, with no significant morbidity of the donor area.     

A study of nail bed injuries: causes, treatment, and prognosis

Two hundred ninety-nine nail bed injuries were studied over a 5 1/2-year period. Methods of repair were described. Follow-up was obtained for 184 injuries. The injuries were defined, categorized, and analyzed according to defined result categories and results were graded from excellent to poor. Ninety percent of the repaired nail beds were graded good to excellent. Poorer results occurred with crush or avulsion injuries, with injuries of both nail bed and nail fold, and with associated infection.     

Long-term sequel of nail bed trauma

 We report the long term sequel of a finger tip injury (case report). Attention to detail, particularly in repairing the nail bed and a decision at the time to either retain and repair, or excise fully, the germinal matrix could avoid long term complications. Received: 5 November 1996 / Accepted: 8 May 1997     

自体真皮结合指(趾)甲床组织片修复甲床缺损78例分析

目的 探讨利用自体真皮结合伤指剩余甲床组织片移植治疗甲床缺损的方法及疗效.方法 对78例88指甲床缺损40％～90％,且均有骨外露的患者,利用自体真皮结合伤指的剩余甲床或切取自身足趾甲床结合移植于甲床缺损处,打包加压包扎,术后2周拆线,观察治疗效果.结果 本组共78例88指,术后自体真皮结合甲床组织片移植均Ⅰ期成活,2例部分坏死,经换药后愈合.新生甲板经3～4个月,覆盖修复甲床.随访6～12个月,88指中甲床恢复达优良86指(占97.7％),差2指(占2.2％).结论 采用自体真皮结合甲床组织片移植修复甲床缺损,方法简单,取材方便,无甲分离及指甲质脆等问题,效果理想,易于推广应用.     

外伤性甲床缺损的修复

目的报道一种治疗甲床缺损的新方法及其疗效。方法对17例29指甲床缺损者，于甲床缺损区末节指骨背侧钻孔、换药，待肉芽生长，最后达瘢痕愈合，以瘢痕替代甲床。结果29指甲床缺损区创面全部瘢痕愈合，术后随访3~6个月，指甲全部再生，疗效优者16指，良7指，可4指，差2指，总优良率79％。结论该方法操作简便，可最大限度恢复指甲形态，是修复甲床缺损的有效方法。