Fingertip reconstruction with a subcutaneous flap and composite graft composed of nail bed and volar pulp skin

Abstract

Background Fingertip injuries are very common; however, the reconstruction of volar pulp defects with nail bed defects is challenging in the absence of the amputated segment. We reconstructed fingertip amputations with nail bed defects using a new surgical approach: a subcutaneous flap and composite graft.Methods We treated 10 fingertip amputation patients without an amputated segment, with exposed distal phalangeal bone and full-thickness nail bed defects between February 2018 and December 2020. All patients underwent two-stage surgery: in the first stage, a subcutaneous flap was performed to cover the exposed distal phalanx, and in the second stage, a composite graft, consisting of nail bed, hyponychium, and volar pulp skin, was applied over the subcutaneous flap.Results All flaps survived and all composite grafts were successful. The wounds healed without any significant complications, including the donor site. The average follow-up duration was 11.2 months (range, 3–27 months). The new nail and the shape of the volar pulp were evaluated during follow-up. All patients were satisfied with their natural fingertip shapes and the new nails did not have any serious deformities.Conclusions A subcutaneous flap in combination with a composite graft fitting the shape of the defect could be another option for fingertip injuries without amputated segments.

Fingertip Amputations Repair with V-Y Flap and Polyethylene Nail

“…Although replantation surgery is a frequently used method, it can be impossible for a variety of reasons, including excessive crushing, contamination, multilevel injury, or other associated injuries 2 . Besides, the failure rates due to venous congestion are high in distal amputations, due to the lack of suitable veins for anastomosis 3 . Since replantation is often difficult in fingertip amputations, it is known that other reconstructive methods for fingertip amputation such as Moberg flap, volar V-Y advancement flap, thenar flap and small free flap are good treatment options; but these options cannot recreate the nail bed 4 .…”