The palmar nail syndrome. Case report

The congenital ectopic nail is very rare and usually present as an ectopic abnormal nail alongside the normal fingernail. Ridder described in 1992 the "congenital palmar nail syndrome" sharing a palmar ectopic nail, a loss of flexion and a small distal phalanx on x-ray. We report a case of a congenital palmar nail syndrome of both little fingers on a boy 13 years old.     

Dorsal dimelia in patau syndrome: a case report

We present a case of a child with Patau syndrome that exhibits features consistent with congenital palmar nail syndrome. The literature is reviewed and evidence presented to demonstrate that this is a defect in the dorso-ventral patterning of the limb and thus a form of dorsal dimelia. In order to differentiate this from other instances of ectopic nail tissue we suggest congenital palmar nail syndrome should be more specifically defined as duplicated nails, absent flexion creases, non-glabrous skin on the palmar surface, reduced movement at the interphalangeal joints and hypoplastic terminal phalanges.     

Application of the palmar pocket method for total nail reconstruction without vascular anastomoses

We present a case of a nail defect, which was reconstructed by free composite nail combined with the palmar pocket method without vascular anastomoses. A 40-year-old man lost his nail of the right middle finger by trauma 1 year ago. A total nail composite graft, composed of germinal and sterile matrices, and proximal nail fold, from which the nail plate was removed, was harvested from the ipsilateral first toe and was grafted on the right middle fingertip. The grafted nail was inserted into the palmar subcutaneous pocket. Fourteen days after the first operation, the grafted part was removed from the pocket, and active bleeding was noted on the sterile matrix. Seven months after the second surgery, the nail had grown and had an almost normal appearance. There was no conspicuous scar at either the recipient or the donor site.     

Two families with congenital nail anomalies: Nail formation in ectopic areas

Two families with congenital nail anomalies are reported. The nail covered not only the dorsal but also some of the palmar aspect of the distal phalanx. The ungual phalanges of the affected fingers were lacking in the crescent-shaped cap and had a blunt Y-shaped bony projection. The anomalies may have been transmitted by an autosomal recessive gene.     

Escalator flap in the treatment of claw nail]

Nail horn deformity can be corrected by a proximal withdrawal of the nail complex on the distal remaining skeleton. The main problem is the flap coverage and we have combined an "in bloc" O'Brien island flap with the withdrawal of the nail. This "escalator" technique allowed a good correction with a satisfactory palmar skin cover and a decreased "wave" of the dorsal skin.     

Heritable nail diseases

Heritable nail diseases are associated with a great variety of inherited diseases and syndromes. Well over 60 HEDs and numerous other inherited nail abnormalities are known to exist. A classification system of these disorders, as well as the specific nail change found in each, has been presented. Table 1 has been included to correlate many of the nail disorders with their corresponding inherited disease or syndrome. Clinically, inherited nail diseases may appear to be of questionable importance. In cases of primary presentation or poor historical background, however, these subtle nail changes may prove useful in arriving at or substantiating a diagnosis.     

Thoracic surgical implications of the yellow nail syndrome

Idiopathic lymphedema associated with yellow discoloration of the nail beds constitutes the yellow nail syndrome. Pleural effusions and chronic sinusitis are also frequently present. This report describes a case of yellow nail syndrome in a 65-year-old woman.     

Fingertip reconstruction with flaps and nail bed grafts

We retrospectively reviewed the cases of 14 fingertips reconstructed with a combination of local or regional flaps and nail bed grafts, some of which were placed wholly or partially over a de-epithelialized flap. Most of the fingertips sustained a crushing injury and were reconstructed at the time of the injury. Soft tissue coverage was provided by palmar V-Y flaps in 6 cases, thenar flaps in 4, lateral V-Y flaps in 2, a Moberg flap in 1, and a cross-finger flap in 1. Split toenail bed grafts were used in 6 cases, full-thickness nail bed grafts from the amputated part in 6, and split nail bed grafts from the injured digit in 2. There was 1 partial graft loss and 1 partial flap loss. The remaining cases had completely successful grafts and good soft tissue healing. Subsequent nail growth and adherence were good in all but the 1 digit requiring secondary composite grafting.     

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.     

Yellow nail syndrome associated with thiol compound therapy for rheumatoid arthritis. Two case reports

Yellow nail syndrome is characterized by ungual dystrophy, lower limb lymphedema, and pleural effusions or bronchiectasis. Rheumatoid arthritis is the autoimmune disorder most often associated with yellow nail syndrome. We report two new cases of yellow nail syndrome in patents receiving thiol compound therapy for rheumatoid arthritis. Eight similar cases have been reported since 1979, suggesting a possible causative effect of this class of drugs.     

Vascularized nail flap vs. free nail graft

Summary With recent improvements in microvascular surgery, the vascularized nail flap procedure has had considerable success. On the other hand, free nail graft without microvascular anastomoses is still used but little has been published to make a comparison between these two procedures. Thus, it is not known which is the better procedure. In the past, hand nail defects in 12 patients have been reconstructed by the free nail graft procedure and in four patients by vascularized nail flap procedure. In this article, the free nail graft is compared with the vascularized nail flap and the merits and demerits of both techniques are presented. Requests for reprints: T. Endo, M.D.     

Microvascular nail transfer

A composite of nail and its skin appendages can be transferred for the foot to the hand by microvascular anastomosis. For technical reasons, the most suitable donor nail is from the big toe, and this most closely approximates the thumb nail. A finite portion of hemipulp must be included with the transfer to ensure adequate vascularization. Nail size can be reduced by resection of the edges of the germinal matrix so as to match the donor defects. For finger nail reconstruction, it is usually more practical to transfer the whole of the tip of the second or third toe to replace the whole of the tip of the finger. The indications of nail reconstruction by this technique are relatively rare and are predominantly cosmetic.     

Lymphoedema of the eyelids in the yellow nail syndrome

The nails are frequently deformed or otherwise affected in a very large number of systemic diseases or as part of the general picture in many syndromes of congenital origin. One of the latter is the yellow nail syndrome (Samman and White, 1964) an example of which we present in this paper.     

Implantation of a pleurovenous shunt for massive chylothorax in a patient with yellow nail syndrome

Yellow nail syndrome is a type of lymphatic dysplasia syndrome characterised by the triad of yellow nails, lymphoedema, and pleural effusions. The case history is presented of a 70 year old patient with yellow nail syndrome who complained of dyspnoea caused by massive chylothorax. The patient underwent insertion of a pleuroperitoneal shunt which resulted in abdominal distension and deterioration of leg oedema. The pleuroperitoneal shunt was replaced by a pleurovenous shunt on the right side which led to an improvement in the bilateral pleural effusions, abdominal distension, and leg oedema. A pleurovenous shunt may be an alternative rescue therapy for yellow nail syndrome.     

Familial nail patella-syndrome]

Nail patella-syndrome is a rare hereditary (autosomal dominant) disorder resulting from a heterogenous loss of function in the LMXB1 gene on chromosome 9q34. It is associated with multiple deformities. Patients have a characteristic tetrad of pathologic symptoms including fingernail dysplasia, hypoplastic or absence patella, radial head dislocation, iliac horns and in some cases nephropathy and ophtalmo-logical findings (glaucoma). In this study four affected members in one family are presented. All of the familly members presented absence or hypoplastic patella and fingernails dysplasia. There were not indications for surgical treatment dislocated radial heads or subluxated dysplastic patella. Genetic counseling is recomended because nail patella syndrome is an autosomal dominant disease.     

Distal replantation,nail bed,and nail problems in musicians

Nails enhance pulp sensibility, increase pulp stability and are necessary for fine prehension. A finger without a nail will compromise a musician's career if the finger involved is necessary to play a note (strings, keyboards) or hold a position (winds). Salvage of the nail is then a very important part of any surgical procedure in musicians with distal finger trauma. Surgical techniques will depend on the level and type of nail injury. Replantation is by far the best technique in distal finger amputation but, when not feasible, reposition-flap repair may be used. In isolated nail lesions, sutures, split-thickness nail bed graft, or nail matrix flaps are used according to the level and severity of the lesion.     

The microvasculature of the nail bed, nail matrix, and nail fold of a normal human fingertip

The organization of the microvasculature of the dorsal human fingertip based on a vascular corrosion cast was examined using a stereoscopic microscope. The variations of the superficial capillary network of the 3 specialized areas of skin of the dorsal fingertip (the nail bed, the nail matrix, and the nail fold) are described. In the nail bed numerous capillary loops were observed arising from a deeper regular arrangement of sagittally aligned, parallel rows of vessels. The size and direction of inclination of the capillary loops varied, getting longer and more inclined to the nail bed distally, with the longest capillary loops seen at the hyponychium. There were no capillary loops at the nail matrix region, but there was a single, layered, rectangular plexus of capillaries in the plane of the nail matrix. This extended distally to sagittally stretched coils of vessels that straightened out as the nail matrix enters the nail bed region. At the edge of the proximal nail fold the capillary loops looked like fine bristles and were approximately 3 times shorter than those found on the nail bed and hyponychium. This study provides a baseline for future work in understanding the changes in the microvasculature of the dorsal fingertip due to injury or pathology.     

Minimally invasive femoral nail extraction

Introduction Case report about a minimally invasive technique for removal of a femoral antegrade nail (FAN). Femoral nails are introduced by minimally invasive techniques, but are often removed with more invasive surgery.Materials and methods Four cases of young patients are described in whom the femoral nail was removed after consolidation by a minimally invasive extraction technique at the trochanteric site. By using a threaded wire for locating the proximal entrance of the femoral nail followed by reaming over the wire, the entrance of the nail in the trochanteric region is freed. Then the extraction bolt can be placed over the wire and the nail can be extracted through the same incision as it was inserted in, without enlarging the incision.Discussion This case report discusses a technique for minimally invasive femoral nail extraction, not the necessity of removing nails. Leaving out the endcap at the initial operation is the only preoperative condition, since the endcap blocks the entrance of the nail. This operation is done with fluoroscopic guidance. The difficult part is the reaming. The reamer must not be damaged when approaching the nail entrance. This minimally invasive femoral nail extraction technique is applicable for various types of femoral nails.Conclusion Minimally invasive extraction of femoral nails is possible and needs more attention. The level of evidence is a level IV case series.Concerning funding, there was no financial support for this report.     

Renal transplantation for the nail patella syndrome

A patient with the nail patella syndrome (Fong's disease) with end stage renal failure received a renal transplant from his mother. There has been no recurrence of the disease in the year since transplantation. Such patients are apparently good candidates for transplantation, although careful selection of the donor from among the potentially affected family members should be conducted. In addition, the orthopedic and metabolic disabilities that characterize this disease may render these patients more susceptible to aseptic necrosis of the hips.     

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.