Reconstruction for Defects of Total Nail Bed and Germinal Matrix Loss with Acellular Dermal Matrix Coverage and Subsequently Skin Graft

Liu, Tsung-Hsien; Hsieh, Meng-Chien Willie; Chou, Po-Ching; Huang, Shu-Hung

doi:10.3390/medicina56010017

Cited by 11 publications

(14 citation statements)

References 14 publications

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“…After the development of acellular dermal matrix (ADM), nail bed reconstruction with ADM and a split-thickness skin graft (STSG) were recently introduced [ 11 ]. Although this method has certain advantages, including minimal functional deficits and donor site morbidity, it may not be suitable for complex crush trauma patients.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…The wound repair following the resection of the whole nail is also a brainteaser. In clinical practice, skin grafts for repairing the nail soft tissue defects with phalanx exposure often presented with the hypertrophic scar at recipient site [16] . The llet ap with the phalanx shortening often requires the sacri ce of the distal phalanx [15] .…”

Section: Discussionmentioning

confidence: 99%

“…All patients obtained the excellent function and aesthetic outcomes, and all patients were satis ed. The lateral toe pulp island ap provides several merits over the use of conventional aps [15][16][17] , including short operation time, simple ap dissection, minimal donor site morbidities, and outstanding functional and aesthetic outcomes. In addition, the texture and color of the toe pulp is similar to that of the toenail because the toe pulp has a thicker cuticle.…”

Section: Discussionmentioning

confidence: 99%

“…For the subungual melanocytic nevi with the pigmentation on lateral one-third of nail, lateral longitudinal excision was carried out [2] . For the subungual melanocytic nevi with the pigmentation on the whole nail, the whole nail was resected and then the wound was covered by skin grafts, llet ap with the phalanx shortening, and free ap [2,[15][16][17] . Importantly, these options change post-operative nail appearance and cannot obtain a well aesthetic outcome.…”

Section: Introductionmentioning

confidence: 99%

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Mimical Reconstruction and Aesthetic Repair of the Nail After Resection of Subungual Melanocytic Nevus

Cao

et al. 2021

Preprint

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Background: Previous studies have shown about 25% - 33% of cutaneous melanomas result from melanocytic nevi. Currently, there are no consensus on treatment of the subungual melanocytic nevi with the pigmented band width > 3mm. However, some options change post-operative nail appearance and cannot obtain a well aesthetic outcome. The purpose of this study is to report the outcomes of mimical reconstruction and aesthetic repair of the nail.Methods: When the width of the pigmented bands was more than 1/2 of the whole nail width, the mimical reconstruction of the nail, the lateral toe pulp island flap covered the wound via the subcutaneous channel, was performed. If the width of the pigmented bands ranged from 1/4 to 2/5 of the entire nail, the aesthetic repair of the nail, the split-thickness excision under microscope, would be carried out.Results: The average age at the time of surgery was 14.5 years. The lesions were located at the toes in 5 patients and fingers in 3 patients. No complications occurred postoperatively. In 5 patients with the mimical reconstruction of the nail, all of toenail showed well-settled flap. In three patients with the aesthetic repair of the nail, there was no nail malnutrition or deformity, and all nails have an aesthetic appearance.Conclusions: Mimical reconstruction and aesthetic repair of the nail following resection of subungual melanocytic nevus is a reliable and feasible. It seems to be satisfactory that “like tissue” repairs the complex nail defects. All patients obtain an excellent aesthetic outcome.

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“…Wound repair following resection of a whole nail is also a brainteaser. In clinical practice, skin grafts used to repair soft tissue defects of the nail with phalanx exposure often results in a hypertrophic scar at the recipient site [ 16 ]. A fillet flap with phalanx shortening often requires sacrificing the distal phalanx [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Mimical reconstruction and aesthetic repair of the nail after resection of subungual melanocytic nevus

Cao

et al. 2021

BMC Surg

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Background This study aimed to report the outcomes of mimical reconstruction and aesthetic repair of the nail. Methods When the pigmented bands were more than 1/2 the width of the whole nail, mimical reconstruction of the nail was performed, with a lateral toe pulp island flap covering the wound via the subcutaneous channel. If the pigmented bands were 1/4 to 2/5 the width of the entire nail, aesthetic repair of the nail was carried out by split-thickness excision under a microscope. Results The average age of patients at the time of surgery was 14.5 years. Five patients had lesions on their toes, while three had lesions on their fingers. There were no post-operative complications. All toenails of the five patients who had undergone mimical reconstruction exhibited a well-settled flap. The nails of the three patients who underwent aesthetic repair displayed no nail malnutrition or deformity, and all nails had an aesthetic appearance. Conclusions Both mimical reconstruction and aesthetic repair of the nail following resection of subungual melanocytic nevus are reliable and feasible. The “like tissue” repairs of complex nail defects appear to be satisfactory. All patients had excellent aesthetic outcomes. Level of evidence V

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Reconstruction for Defects of Total Nail Bed and Germinal Matrix Loss with Acellular Dermal Matrix Coverage and Subsequently Skin Graft

Cited by 11 publications

References 14 publications

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

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

Mimical Reconstruction and Aesthetic Repair of the Nail After Resection of Subungual Melanocytic Nevus

Mimical reconstruction and aesthetic repair of the nail after resection of subungual melanocytic nevus

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