Effectiveness of finger reconstruction using nail flap anastomosing nerve branch of the first toe nail bed_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Xuechuan ¹ , ZHANG Lingling ² , SUN Changsheng ² , ZHANG Hui ² ,  LI Wenjun ²

1. Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China;
2. Department of Hand and Foot Microsurgery, Shanghai Zhongye Hospital, Shanghai, 201941, P. R. China;

Corresponding author：

LI Wenjun, Email: yingziduizhang@163.com

Keywords：

Finger reconstruction; nail bed reconstruction; fingertip defect; nerve branch of the first toe nail bed

DOI：

10.7507/1002-1892.202310038

Video：

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Objective To investigate the effectiveness of finger reconstruction using nail flap anastomosing the nerve branch of the first toe nail bed. Methods Between January 2016 and December 2022, 18 patients (18 fingers) with thumb or finger nail bed defects were admitted. There were 12 males and 6 females, with an average age of 32 years (range, 19-42 years). Four cases were finger tip tissue damage caused by machine compression, and 4 cases were distal tissue necrosis after finger replantation. There were 9 cases of thumb injury, 3 cases of index finger injury, 5 cases of middle finger injury, and 1 case of ring finger injury. There were 11 cases of distal nail damage and 7 cases of distal nail root (including nail root) damage. The time from injury to admission was 1-5 hours, with an average of 2 hours. After debridement and anti-infection treatment for 5-7 days, the wounds in size of 1 cm×1 cm to 4 cm×3 cm were reconstructed by using nail flaps anastomosing the nerve branches of the first toe nail bed. The size of the nail flaps ranged from 1.5 cm×1.5 cm to 4.5 cm×3.5 cm. The donor sites were repaired with the flaps in 16 cases and skin graft in 2 cases. Results All nail flaps, flaps, and skin grafts survived after operation and the wounds healed by first intention. All patients were followed up 6-12 months (mean, 10 months). The nails of 18 cases were all grown, in which 16 cases had smooth nails with satisfactory appearances, 1 case had uneven nails, and 1 case had obvious scar hyperplasia around the suture opening. At 6 months after operation, the two-point discrimination of the skin flap was 4-8 mm (mean, 6 mm). Meanwhile, the skin grafts and flaps at the donor sites regained protective sensation, good abrasion resistance, and had no negative effect upon walking and wearing shoes. Conclusion The application of a nail flap that anastomoses the nerve branch of the first toe nail bed for finger reconstruction has minimal damage and can achieve good nail bed repair results.

Citation： LI Xuechuan, ZHANG Lingling, SUN Changsheng, ZHANG Hui, LI Wenjun. Effectiveness of finger reconstruction using nail flap anastomosing nerve branch of the first toe nail bed. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(12): 1496-1500. doi: 10.7507/1002-1892.202310038 Copy

1.	程国良, 方光荣, 侯书健, 等. 拇手指部分缺损的修饰性修复与重建. 中华医学杂志, 2005, 85(38): 2667-2673.
2.	杨小文, 江吉勇, 曾凡雨, 等. 部分足趾游离移植修饰性再造指尖部缺损. 实用手外科杂志, 2023, 37(2): 190-192.
3.	Chen Z, Li M, Huang S, et al. The role of great toe terminal branch artery split-thickness nail bed flaps in fingertip reconstruction surgery. J Plast Reconstr Aesthet Surg, 2023, 84: 642-649.
4.	李文涛, 王斌, 谷彬彬, 等. 儿童微指尖再植8例. 实用手外科杂志, 2022, 36(1): 89-90.
5.	李文君, 苏波, 张玲玲, 等. 踇甲皮瓣再造指尖. 中华手外科杂志, 2016, 32(3): 202-204.
6.	Hong MK, Park JH, Koh SH, et al. Microsurgical free tissue options for fingertip reconstruction. Hand Clin, 2021, 37(1): 97-106.
7.	Wang Y, Hu Y, Lian X, et al. Toenail composite tissue flap as a novel reconstructive approach in the treatment of macrodactyly of foot. Plast Reconstr Surg, 2023.
8.	Cai L, Zhang X, Zhang Y, et al. Reconstruction of composite soft tissue defect in the distal finger using partial toenail flap transfer. Orthop Surg, 2023, 15(10): 2716-2723.
9.	Zhou X, Sun D, Liu F, et al. A mini hallux neurovascular osteo-onychocutaneous free flap for refined reconstruction of distal defects in thumbs and fingers. J Plast Surg Hand Surg, 2023, 57(1-6): 415-421.
10.	Koh SH, You Y, Kim YW, et al. Long-term outcomes of nail bed reconstruction. Arch Plast Surg, 2019, 46(6): 580-588.
11.	Li F, Wang XQ, Liu MX, et al. Surgical repair for deformities of the nail unit. J Cosmet Dermatol, 2022, 21(11): 5456-5463.
12.	Hu C, Hou B, Huang X, et al. Superficial circumflex iliac artery perforator flap with bilobed design for the donor defect after wrap-around flap transfer reconstruction. Orthop Surg, 2023, 15(3): 899-905.
13.	徐达传, 蔡锦方, 赵志杰, 等. 指、趾甲复合瓣移植的解剖学基础. 中国临床解剖学杂志, 1989, 7(1): 12-14.
14.	王增涛, 王一兵, 丁自海. 显微外科临床解剖学图谱. 山东: 山东科学技术出版社, 2009: 782.
15.	劳杰, 左焕深, 陈德松, 等. 踇趾甲床游离移植的应用解剖. 中华手外科杂志, 1994, 10(4): 231-232.
16.	李文君, 苏波, 张玲玲, 等. 踇趾底动脉背侧支供血的踇甲瓣修复拇和手指甲床及软组织缺损. 中华显微外科杂志, 2014, 37(1): 22-25.

1. 程国良, 方光荣, 侯书健, 等. 拇手指部分缺损的修饰性修复与重建. 中华医学杂志, 2005, 85(38): 2667-2673.
2. 杨小文, 江吉勇, 曾凡雨, 等. 部分足趾游离移植修饰性再造指尖部缺损. 实用手外科杂志, 2023, 37(2): 190-192.
3. Chen Z, Li M, Huang S, et al. The role of great toe terminal branch artery split-thickness nail bed flaps in fingertip reconstruction surgery. J Plast Reconstr Aesthet Surg, 2023, 84: 642-649.
4. 李文涛, 王斌, 谷彬彬, 等. 儿童微指尖再植8例. 实用手外科杂志, 2022, 36(1): 89-90.
5. 李文君, 苏波, 张玲玲, 等. 踇甲皮瓣再造指尖. 中华手外科杂志, 2016, 32(3): 202-204.
6. Hong MK, Park JH, Koh SH, et al. Microsurgical free tissue options for fingertip reconstruction. Hand Clin, 2021, 37(1): 97-106.
7. Wang Y, Hu Y, Lian X, et al. Toenail composite tissue flap as a novel reconstructive approach in the treatment of macrodactyly of foot. Plast Reconstr Surg, 2023.
8. Cai L, Zhang X, Zhang Y, et al. Reconstruction of composite soft tissue defect in the distal finger using partial toenail flap transfer. Orthop Surg, 2023, 15(10): 2716-2723.
9. Zhou X, Sun D, Liu F, et al. A mini hallux neurovascular osteo-onychocutaneous free flap for refined reconstruction of distal defects in thumbs and fingers. J Plast Surg Hand Surg, 2023, 57(1-6): 415-421.
10. Koh SH, You Y, Kim YW, et al. Long-term outcomes of nail bed reconstruction. Arch Plast Surg, 2019, 46(6): 580-588.
11. Li F, Wang XQ, Liu MX, et al. Surgical repair for deformities of the nail unit. J Cosmet Dermatol, 2022, 21(11): 5456-5463.
12. Hu C, Hou B, Huang X, et al. Superficial circumflex iliac artery perforator flap with bilobed design for the donor defect after wrap-around flap transfer reconstruction. Orthop Surg, 2023, 15(3): 899-905.
13. 徐达传, 蔡锦方, 赵志杰, 等. 指、趾甲复合瓣移植的解剖学基础. 中国临床解剖学杂志, 1989, 7(1): 12-14.
14. 王增涛, 王一兵, 丁自海. 显微外科临床解剖学图谱. 山东: 山东科学技术出版社, 2009: 782.
15. 劳杰, 左焕深, 陈德松, 等. 踇趾甲床游离移植的应用解剖. 中华手外科杂志, 1994, 10(4): 231-232.
16. 李文君, 苏波, 张玲玲, 等. 踇趾底动脉背侧支供血的踇甲瓣修复拇和手指甲床及软组织缺损. 中华显微外科杂志, 2014, 37(1): 22-25.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of finger reconstruction using nail flap anastomosing nerve branch of the first toe nail bed

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