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KMID : 1038220220490010070
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Archives of Plastic Surgery
2022 Volume.49 No. 1 p.70 ~ p.75
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Fingertip reconstruction with a subcutaneous flap and composite graft composed of nail bed and volar pulp skin
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Koh Sung-Hoon
Park Ilou
Kim Jin-Soo
Lee Dong-Chul
Roh Si-Young
Lee Kyung-Jin
Hong Min-Ki
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Abstract
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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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KEYWORD
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Finger injuries, Nails, Surgical flap
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