Pedicled Osteo-Onchyocutaneous Island Flap for Finger Macrodactyly: A Review of Literature.

We present a case of middle finger macrodactyly reconstructed in a single stage using multiple techniques. We elevated a pedicled osteo-onychocutaneous island flap, excised the remnant distal phalanx with a segment of 1 digital nerve and skin over the dorsum of the middle phalanx, performed epiphysiodesis and reduction of the middle phalanx as well as soft-tissue debulking, and inset the flap over the dorsum of the middle phalanx. Follow-up at 12 months revealed a satisfactory aesthetic and functional outcome.

A new surgical strategy for reconstruction of claw nail deformity.

Claw nail deformity is common in patients with fingertip injury. The optimal reconstruction remains unclear. We devised a unique strategy for reconstruction of claw nail deformity. We divided the approach into three parts: soft tissue reconstruction, bone graft and nail bed graft. In the soft-tissue reconstruction, a reverse digital arterial finger flap for the finger or an extended palmar flap advancement with V-Y plasty for the thumb was selected. A part of the distal phalanx of the second toe including periosteum was harvested as a bone graft. A nail bed graft from the big toe was performed. We reconstructed in 11 cases of claw nail deformity using our strategy. All cases achieved significant improvement with no recurrence of the claw nail deformity. Moreover, there was no donor site morbidity.

Nail bed and flap reconstructions for acute fingertip injuries - A case review and report of a chemical burn injury.

Nail bed injuries were commonly found concomitantly with fingertip injuries. Reconstruction of fingertip including the nail bed should be attempted at acute stage. Aim of the surgery was to restore as much finger length and achieve normal nail growth. In chemical burns, the initial presentation might not reflect the exact extent of injury. Appropriate acute management must be initiated while waiting for demarcation. We report a case of young stewardess who presented with fingertip chemical burn injury. Surgical debridement was done on third day post-injury. A cross-finger flap to cover skin defect and split-thickness nail bed grafting from the remnant of injured finger were done. Excellent functional and cosmetic outcome was achieved in 6 months. Surgical treatment in a chemical burn was similar to traumatic injury. Nail bed graft was the best option for nail bed reconstruction. In cases of soft tissue loss, advancement or pedicle flaps are beneficial.

Does Graft on Flap Method Work on Sequela of Fingertip Amputation?

The graft on flap method, a useful option for the restoration of fresh fingertip amputation, was applied to the reconstruction of the short fingertip stumps resulting from the initial amputated stump plasties. As a modification, a nail bed graft from the big toe and a small cubic iliac bone graft were substituted for the lost tissues normally reduced as a composite graft in fresh cases. Upon follow-up ranging from 1 to 8 years, the grafted bone was found to have been resorpted in all cases. For the reconstruction of short fingertip stumps after the initial amputated stump plasties, acceptable results have not yet been achieved using the graft on flap method.

Thin Split-Thickness Toe Nail-Bed Grafts for Nail Bed Defects in Subungal Exostosis: Two Cases Report / 대한골관절종양학회지

We reviewed the clinical features of 2 patients who underwent surgery for subungal exostosis, focusing on postoperative deformity of the nail. The lesion destroyed the nail bed and was excised with a direct approach. then thin split-thickness sterile matrix graft was done after excision of the tumor because the defect of the nail bed was large. Good postoperative appearance of the nail was obtained by thin split-thickness sterile matrix graft. The use of thin split-thickness sterile matrix graft for the replacement of a nail bed defect can regain a smooth, adherent, and normal-looking nail and avoid donor-site morbidity. Thin split-thickness toe-nail bed graft is a good choice for the prevention of postoperative deformity.

Nail Bed Resurfacing with Split-Thickness Nail Bed Graft

The presence of a fingernail is important in facilitating tactile sensibility to finger pulp, stabilizing the tip for refined pinch, scratching and providing dorsal protection. Many reconstructive procedures have been introduced in the past for reconstruction of the nail. The authors performed a reconstruction of the nail in 13 patients using a split-thickness nail bed graft. Results of nail growth in reconstructed nail were judged as good, fair, or poor on the basis of appearance of nail and the patient's satisfaction. The outcome of the 13 cases (mean follow-up of 11 months) was good in eight cases, fair in three cases, and poor in two cases, respectively. Although the authors' experience suggests the unpredictable nature of nail bed graft, it should be considered for patients who desire nail reconstruction and are not candidates for ablation or vascularized nail complex transfer procedure.

Tratment of the Nail Bed Avulsion Injury with Split-thickness Nail Bed Graft / 대한정형외과학회잡지

The primary goal in the treatment of the nail bed avulsion injury is complete regrowing of the nail plate without any deformity. There are many procedures for treatment of the nail bed avulsion injury as a split-thickness skin graft, full-thickness nail bed graft, reverse dermal graft or split-thickness nail bed graft. From February, 1984 to June, 1985 at In-Chon Gill Hospital, 13 cases of nail bed avulsion injury were treated with split-thickness nail bed grafts. The intact residual part of the injured nail bed or the toe nail bed was served as a donor site. The results were as followings; 1. The incidence of nail bed avulsion injury of all hand injuries was 9.7%. 2. The main cause of injury was the industrial accident and more prevalent in the left hand. 3. The good result was obtained in the split-thickness nail bed graft for the nail bed avulsion injury, but in nail root portion, the poor result was noticed. 4. The average time for normal nail appearance is six months.