Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Long-term outcomes of nail bed reconstruction

  • Koh, Sung Hoon (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital) ;
  • You, Youngkee (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital) ;
  • Kim, Yong Woo (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital) ;
  • Kim, Jin Soo (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital) ;
  • Lee, Dong Chul (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital) ;
  • Roh, Si Young (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital) ;
  • Lee, Kyung Jin (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital) ;
  • Hong, Min Ki (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital)
  • Received : 2019.07.26
  • Accepted : 2019.10.18
  • Published : 2019.11.15
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Abstract

Background There are various reconstructive options for nail bed defects. However, it is challenging not to leave a deformity. In this study, we investigated differences in outcomes depending on the reconstruction method, attempted to determine which method was better, and analyzed other factors that may affect outcomes. Methods The long-term outcomes of nail bed reconstruction were reviewed retrospectively. We performed three types of reconstruction depending on the defect type: composite grafts of severed segments, nail bed grafts from the big toe, and two-stage surgery (flap coverage first, followed by a nail bed graft). Subsequent nail growth was evaluated during follow-up, and each outcome was graded based on Zook's criteria. The reconstruction methods were statistically analyzed. Other factors that could contribute to the outcomes, including age, the timing of surgery, germinal matrix involvement, defect size, and the presence of bone injuries, were also compared. Results Twenty-one patients (22 digits) who underwent nail bed reconstruction were evaluated. The type of reconstruction method did not show a significant relationship with the outcomes. However, patients who sustained injuries in the germinal matrix and patients with a defect larger than half the size of the nail bed had significantly worse outcomes than the comparison groups. Conclusions The results suggest that no operative method was superior to another in terms of the outcomes of nail bed reconstruction. Nevertheless, involvement of the germinal matrix and defect size affected the outcomes.

Keywords

References

  1. Sommer NZ. The perionychium. In: Wolfe SW, Hotchkiss RN, Pederson WC, et al. editors. Green's operative hand surgery. 7th ed. Philadelphia: Elsevier; 2016. p. 318-37.
  2. Clayburgh RH, Wood MB, Cooney WP 3rd. Nail bed repair and reconstruction by reverse dermal grafts. J Hand Surg Am 1983;8(5 Pt 1):594-8. https://doi.org/10.1016/S0363-5023(83)80134-8
  3. Brown RE, Zook EG, Russell RC. Fingertip reconstruction with flaps and nail bed grafts. J Hand Surg Am 1999;24:345-51. https://doi.org/10.1053/jhsu.1999.0345
  4. Shepard GH. Nail grafts for reconstruction. Hand Clin 1990; 6:79-102. https://doi.org/10.1016/S0749-0712(21)01246-4
  5. Endo T, Nakayama Y. Microtransfers for nail and fingertip replacement. Hand Clin 2002;18:615-22. https://doi.org/10.1016/S0749-0712(02)00077-X
  6. Nam SB. The perionychium. In: The Korean Society for Surgery of the Hand, editor. Surgery of the hand. 1st ed. Seoul: Bumoon Education; 2014. p. 155-61.
  7. Shepard GH. Management of acute nail bed avulsions. Hand Clin 1990;6:39-56. https://doi.org/10.1016/S0749-0712(21)01241-5
  8. Tran LE, Berry GJ, Fee WE Jr. Split-thickness skin graft attachment to bone lacking periosteum. Arch Otolaryngol Head Neck Surg 2005;131:124-8. https://doi.org/10.1001/archotol.131.2.124
  9. Lee KJ, Kim YW, Kim JS, et al. Nail bed defect reconstruction using a thenar fascial flap and subsequent nail bed grafting. Arch Plast Surg 2019;46:57-62. https://doi.org/10.5999/aps.2018.00227
  10. Zaias N. Embryology of the human nail. Arch Dermatol 1963;87:37-53. https://doi.org/10.1001/archderm.1963.01590130043010
  11. De Berker D, Mawhinney B, Sviland L. Quantification of regional matrix nail production. Br J Dermatol 1996;134: 1083-6. https://doi.org/10.1111/j.1365-2133.1996.tb07947.x
  12. Johnson M, Shuster S. Continuous formation of nail along the bed. Br J Dermatol 1993;128:277-80. https://doi.org/10.1111/j.1365-2133.1993.tb00171.x
  13. Lewis BL. Microscopic studies of fetal and mature nail and surrounding soft tissue. AMA Arch Derm Syphilol 1954; 70:733-47. https://doi.org/10.1001/archderm.1954.01540240038005
  14. Baden HP. Regeneration of the nail. Arch Dermatol 1965; 91:619-20. https://doi.org/10.1001/archderm.1965.01600120051011
  15. Brucker MJ, Edstrom L. The use of grafts in acute and chronic fingernail deformities. J Hand Surg Am 2002;2:14-20. https://doi.org/10.1016/S1531-0914(02)80004-3
  16. Zook EG, Van Beek AL, Russell RC, et al. Anatomy and physiology of the perionychium: a review of the literature and anatomic study. J Hand Surg Am 1980;5:528-36. https://doi.org/10.1016/S0363-5023(80)80100-6
  17. Shepard GH. Treatment of nail bed avulsions with split-thickness nail bed grafts. J Hand Surg Am 1983;8:49-54. https://doi.org/10.1016/S0363-5023(83)80052-5
  18. Saito H, Suzuki Y, Fujino K, et al. Free nail bed graft for treatment of nail bed injuries of the hand. J Hand Surg Am 1983;8:171-8. https://doi.org/10.1016/S0363-5023(83)80010-0
  19. Zook EG, Guy RJ, Russell RC. A study of nail bed injuries: causes, treatment, and prognosis. J Hand Surg Am 1984;9: 247-52. https://doi.org/10.1016/S0363-5023(84)80153-7
  20. Koshima I, Soeda S, Takase T, et al. Free vascularized nail grafts. J Hand Surg Am 1988;13:29-32. https://doi.org/10.1016/0363-5023(88)90194-3
  21. Hwang E, Park BH, Song SY, et al. Fingertip reconstruction with simultaneous flaps and nail bed grafts following amputation. J Hand Surg Am 2013;38:1307-14. https://doi.org/10.1016/j.jhsa.2013.03.032
  22. Sugamata A. Regeneration of nails with artificial dermis. J Plast Surg Hand Surg 2012;46:191-4. https://doi.org/10.3109/2000656X.2012.685572

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