Objective To investigate the effectiveness of split nail in the emergency treatment of nail bed partial defect. Methods Between February 2008 and August 2011, 27 cases (30 fingers) of nail bed partial defect were treated. There were 19 males (22 fingers) and 8 females (8 fingers) with an average age of 27.4 years (range, 16-64 years). The causes of injury included machine injury in 25 cases and cutting injury in 2 cases. The injured fingers included 5 thumbs, 7 index fingers, 11 middle fingers, and 9 ring fingers. The disease duration ranged from 30 minutes to 7 hours with an average of 4.3 hours. The size of nail bed defect ranged from 4 mm × 3 mm to 9 mm × 5 mm. All defects were repaired with residual split nail (4 mm × 3 mm-10 mm × 6 mm in size). Results The split nail survived in 25 cases (28 fingers), and primary healing of wound was obtained. Exudation occurred in 2 cases (2 fingers) and was cured after symptomatic treatment. Twenty-three patients (25 fingers) were followed up 5-17 months (mean, 11.1 months). At 3-5 months after operation, the fingernail regeneration was observed in all fingers. Except 2 cases (2 fingers) of delayed healing having poor nail growth, the other patients had smooth nail and normal finger tip function without pain. According effectiveness standard for fingernail regeneration, the results were excellent in 15 fingers, good in 6 fingers, fair in 3 fingers, and poor in 1 finger, with an excellent and good rate of 84%. Conclusion It is a simple and effective method to use residual split nail for emergency treatment of nail bed partial defect.
Objective To summarize the effectiveness of radial dorsal fasciocutaneous flap of thumb for repairing severe nail bed defects. Methods Between May 2009 and January 2012, 16 patients with severe nail bed defect were treated with radial dorsal fasciocutaneous flap of the thumb. There were 10 males and 6 females, aged 16-54 years (mean, 36 years). The causes of injury included crush injury in 10 cases, chainsaw injury in 4 cases, and scald in 2 cases; injured fingers were thumb in 3 cases, index finger in 4 cases, middle finger in 5 cases, ring finger in 3 cases, and little finger in 1 case. The time between injury and operation was 2 hours to 8 days (mean, 19.3 hours). Of 16 patients, 9 complicated by distal phalanx fracture. The area of defect ranged from 0.9 cm × 0.6 cm to 2.3 cm × 2.1 cm. According to ZHOU Qingwen’s grading system for nail bed defects, 6 cases were rated as degree III and 10 cases as degree IV. The area of flap ranged from 1.0 cm × 0.6 cm to 2.5 cm × 2.2 cm. Retrograde transposition was performed to repair the thumb defect, and pedicled transposition to repair the 2nd-5th fingers defects. The donor sites were directly sutured or were repaired with skin graft. Results All flaps and skin grafts survived, and wounds healed by first intention. All patients were followed up 6-12 months (mean, 8 months). The color, texture, and contour of the flaps were good. According to total active motion standard, the finger function was assessed as excellent in 10 cases, good in 4 cases, and fair in 2 cases, and the excellent and good rate was 87.5%. Conclusion Radial dorsal fasciocutaneous flap of thumb is a reliable flap with easy dissection and less trauma in repair of severe nail bed defects.
Objective To investigate the effectiveness of using lateral homodigital flaps pedicled with cutaneous branches of digital artery for repairing nail bed defects. Methods Between December 2008 and July 2010, 5 patients with nail bed defects were repaired with lateral homodigital flaps pedicled with cutaneous branches of digital artery. Nail bed defects were caused by crush injury of machine. There were 3 males and 2 females, aged from 22 to 35 years (mean, 28 years). Injured fingers included 3 thumbs, 1 index finger, and 1 middle finger. The size of the defects ranged from 1.1 cm × 1.0 cm to 1.8 cm × 1.2 cm and the size of the flaps ranged from 2.7 cm × 1.3 cm to 3.1 cm × 1.7 cm. The donor sites were covered by skin graft. The time between injury and admission ranged from 1 hour and 12 minutes to 3 hours and 24 minutes (mean, 2.1 hours). Results All flaps and skin grafts survived, and the incision healed by first intention. The follow-up time ranged from 6 to 9 months (mean, 7.5 months). The fingers had good appearance. Four cases gained full postoperative sensory recovery and the two-point discrimination was 4-5 mm at 3 months after operation, but it did not recover in 1 case at last follow-up. According to the functional assessment criteria of upper limb formulated by the Hand Surgery Branch of Chinese Medicine Association, the results were excellent in 4 cases and good in 1 case. Conclusion The lateral homodigital flaps pedicled with cutaneous branches of digital artery can repair nail bed defects without sacrifice of digital artery, and can gain a full sensory recovery. It is a feasible solution for treatment of nail bed defects especially for those unwilling to cause any damage to their toes.