Transverse Eponychial Flap for nail lengthening and fingertip reconstruction
Abstract
Introduction: Fingertip injuries are frequented with loss of pulp and nail complex. Most reconstructive procedures provide either the soft tissue defect coverage or lengthen the nail.Methods: Patients included were more than 10 years of age with fingertip injury of Allen type III and IV with intact eponychium. Transverse Eponychial Flap was used to lengthen the nail lost as well as provide defect coverage. Paired t test, chi square test and Pearson correlation and Mann Whitney test were used for statistical analysis.
Results: Seventeen digits were analyzed. The average lengthening of the nail achieved was 142.4%. The average nail length during follow up was 59.1% of contralateral, with average final nail lengthening achieved was 31%. Reconstruction with Transverse Eponychial flap alone was performed in 58.8% of digits. Four patients (23.52%) had complete near normal nail. Sixteen digits had satisfactory and higher results. With Transverse Eponychial Flap alone it was possible to completely cover 10 fingertips (58.8%), requiring local flaps or skin graft for the remaining cases. Obliquely orientated injuries (76.47%) were more likely to undergo the procedure.
Conclusion: The flap significantly lengthens the nail, and provides satisfactory results. We recommend the use of this flap in defects with Allen type III and IV fingertip injuries.
References
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13. Xing S, Shen Z, Jia W, Cai Y. Aesthetic and functional results from nailfold recession following fingertip amputations. J Hand Surg Am. 2015;40(1):1-7.
14. Raja Sabapathy S, Venkatramani H, Bharathi R, Jayachandran S. Reconstruction of finger tip amputations with advancement flap and free nail bed graft. J Hand Surg Br. 2002;27(2):134-8.
15. Lemperle G, Schwarz M, Lemperle SM. Nail regeneration by elongation of the partially destroyed nail bed. Plast Reconstr Surg. 2003;111(1):167-72; discussion 73.
16. Zook EG, Guy RJ, Russell RC. A study of nail bed injuries: Causes, treatment, and prognosis. The Journal of Hand Surgery. 1984;9(2):247-52.
17. Strauch B, de Moura W. Arterial system of the fingers. J Hand Surg Am. 1990;15(1):148-54.
18. Allen MJ. Conservative Management of Finger Tip Injuries in Adults. Hand. 1980;os-12(3):257-65.
19. Tupper J, Miller G. Sensitivity following volar V-Y plasty for fingertip amputations. J Hand Surg Br. 1985;10(2):183-4.
2. Rai A, Jha MK, Makhija LK, Bhattacharya S, Sethi N, Baranwal S. An algorithmic approach to posttraumatic nail deformities based on anatomical classification. J Plast Reconstr Aesthet Surg. 2014;67(4):540-7.
3. Champagne L, Hustedt JW, Walker R, Wiebelhaus J, Nystrom NA. Digital Tip Amputations from the Perspective of the Nail. Adv Orthop. 2016;2016:1967192.
4. Chen HY, Hsu CC, Lin YT, Yeh JT, Lin CH, Lin CH. Functional and aesthetic outcomes of the fingertips after nail lengthening using the eponychial flap. J Plast Reconstr Aesthet Surg. 2015;68(10):1438-46.
5. Fakin RM, Biraima A, Klein H, Giovanoli P, Calcagni M. Primary functional and aesthetic restoration of the fingernail in distal fingertip amputations with the eponychial flap. J Hand Surg Eur Vol. 2014;39(5):499-504.
6. Goutos I, Jennings CL, Pandya A. Reconstruction of the burnt perionychium: literature review and treatment algorithm. J Burn Care Res. 2011;32(4):451-7.
7. Bakhach J, Demiri E, Guimberteau JC. Use of the eponychial flap to restore the length of a short nail: a review of 30 cases. Plast Reconstr Surg. 2005;116(2):478-83.
8. Lemmon JA, Janis JE, Rohrich RJ. Soft-tissue injuries of the fingertip: methods of evaluation and treatment. An algorithmic approach. Plast Reconstr Surg. 2008;122(3):105e-17e.
9. Merlino G, Carlucci S. A simple modification of the Bakhach's eponychial flap for nail lengthening after fingertip amputation. J Plast Reconstr Aesthet Surg. 2011;64(10):e265-6.
10. Adani R, Marcoccio I, Tarallo L. Nail lengthening and fingertip amputations. Plast Reconstr Surg. 2003;112(5):1287-94.
11. Turner A, Ragowannsi R, Hanna J, Teo TC, Blair JW, Pickford MA. Microvascular soft tissue reconstruction of the digits. J Plast Reconstr Aesthet Surg. 2006;59(5):441-50.
12. Wang L, Yuan SY. A simple and direct procedure for excision of peripheral skin above the nail root to enable nail lengthening after fingertip amputation. J Plast Reconstr Aesthet Surg. 2012;65(9):e265-6.
13. Xing S, Shen Z, Jia W, Cai Y. Aesthetic and functional results from nailfold recession following fingertip amputations. J Hand Surg Am. 2015;40(1):1-7.
14. Raja Sabapathy S, Venkatramani H, Bharathi R, Jayachandran S. Reconstruction of finger tip amputations with advancement flap and free nail bed graft. J Hand Surg Br. 2002;27(2):134-8.
15. Lemperle G, Schwarz M, Lemperle SM. Nail regeneration by elongation of the partially destroyed nail bed. Plast Reconstr Surg. 2003;111(1):167-72; discussion 73.
16. Zook EG, Guy RJ, Russell RC. A study of nail bed injuries: Causes, treatment, and prognosis. The Journal of Hand Surgery. 1984;9(2):247-52.
17. Strauch B, de Moura W. Arterial system of the fingers. J Hand Surg Am. 1990;15(1):148-54.
18. Allen MJ. Conservative Management of Finger Tip Injuries in Adults. Hand. 1980;os-12(3):257-65.
19. Tupper J, Miller G. Sensitivity following volar V-Y plasty for fingertip amputations. J Hand Surg Br. 1985;10(2):183-4.
Published
2023-08-15
How to Cite
MANANDHAR, Krishna.
Transverse Eponychial Flap for nail lengthening and fingertip reconstruction.
J Soc Surg Nep, [S.l.], v. 26, n. 1, p. 3-10, aug. 2023.
ISSN 2392-4772.
Available at: <https://jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=514>. Date accessed: 22 sep. 2023.
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Original Article
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