DOI QR코드

DOI QR Code

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

  • Koh, Sung Hoon (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital) ;
  • Park, Ilou (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, International St. Mary's Hospital)
  • 투고 : 2021.07.01
  • 심사 : 2021.09.30
  • 발행 : 2022.01.15

초록

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.

키워드

참고문헌

  1. Cheung K, Hatchell A, Thoma A. Approach to traumatic hand injuries for primary care physicians. Can Fam Physician 2013;59:614-8.
  2. Satku M, Puhaindran ME, Chong AK. Characteristics of fingertip injuries in children in Singapore. Hand Surg 2015;20:410-4. https://doi.org/10.1142/s021881041550032x
  3. Strauch B, de Moura W. Arterial system of the fingers. J Hand Surg Am 1990;15:148-54. https://doi.org/10.1016/S0363-5023(09)91123-6
  4. Nam YS, Jun YJ, Kim IB, et al. Anatomical study of the fingertip artery in Tamai zone I: clinical significance in fingertip replantation. J Reconstr Microsurg 2017;33:45-8.
  5. Park J, Kim JS, Koh SH, et al. Fingertip reconstruction with subcutaneous island flap and composite graft: a case report. Arch Hand Microsurg 2020;25:282-6. https://doi.org/10.12790/ahm.20.0047
  6. Spyropoulou GA, Shih HS, Jeng SF. Free pulp transfer for fingertip reconstruction: the algorithm for complicated Allen fingertip defect. Plast Reconstr Surg Glob Open 2016;3:e584. https://doi.org/10.1097/GOX.0000000000000569
  7. 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
  8. Atasoy E, Ioakimidis E, Kasdan ML, et al. Reconstruction of the amputated finger tip with a triangular volar flap: a new surgical procedure. J Bone Joint Surg Am 1970;52:921-6. https://doi.org/10.2106/00004623-197052050-00006
  9. Moberg E. Aspects of sensation in reconstructive surgery of the upper extremity. J Bone Joint Surg Am 1964;46:817-25. https://doi.org/10.2106/00004623-196446040-00011
  10. Kutler W. A new method for finger tip amputation. J Am Med Assoc 1947;133:29. https://doi.org/10.1001/jama.1947.62880010007007
  11. Liu TH, Hsieh MC, Chou PR, et al. Reconstruction for defects of total nail bed and germinal matrix loss with acellular dermal matrix coverage and subsequently skin graft. Medicina (Kaunas) 2020;56:17. https://doi.org/10.3390/medicina56010017
  12. 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
  13. Shepard GH. Treatment of nail bed avulsions with splitthickness nail bed grafts. J Hand Surg Am 1983;8:49-54. https://doi.org/10.1016/S0363-5023(83)80052-5
  14. Morrison WA. Microvascular nail transfer. Hand Clin 1990;6:69-77. https://doi.org/10.1016/S0749-0712(21)01244-0
  15. 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