J Korean Soc Surg Hand.  2016 Jun;21(2):77-83. 10.12790/jkssh.2016.21.2.77.

Fingertip Reconstruction with Perionychial Flaps

• Tark KC
• Lee HY
• Lee R
• Kim JH
• Kim DC

• KMID: 2328391
• DOI: http://doi.org/10.12790/jkssh.2016.21.2.77

Abstract

PURPOSE
Out of nail components, nail plate, nail fold, paronychium, hyponychium, nail bed, and matrices are referred to as the perionychium. The authors report the outcomes of perionychial flap for reconstruction of fingertip injuries with nail bed injuries.
METHODS
We performed 8 cases of perionychial flap for fingertip injuries with nail bed injuries between January 2012 and December 2015, and analyzed the outcomes of the reconstruction surgery. The patients evaluated the aesthetic results on a four-point scale, and we measured and evaluated the ratio of axis length of the nail plate compared with collateral side of normal nail plate.
RESULTS
The mean follow up period was 8.4 months, and range of motion of distal interphalangeal joints and sensation of the reconstructed pulp were normal in all patients. After reconstructive surgery the nail plates regrew up to 80% in average compared to the normal side, and the satisfactory score were good to excellent as 3.8 point in average.
CONCLUSION
The reconstruction of fingertip injuries with nail bed injuries using perionychial flap including paronychium and hyponychium is safe and easy procedure and aesthetic outcomes were excellent. The authors consider the perionychial flap as a useful technique for fingertip reconstruction.

Keyword

Nail; Fingertip reconstruction; Perionychial flap

MeSH Terms

Follow-Up Studies
Humans
Joints
Range of Motion, Articular
Sensation

Figure

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  Fig. 1. Schematic design of perionychial flap for finger tip reconstruction. (A) Preoperative view. (B) After extraction of remaining nail, crushed soft tissues were minimally debrided. Comminuted fracture segments of the fingertip were also removed. Hyponychial, paronychial flap was elevated, and a triangular nail bed was excised to provide an ideal rotation of the hyponychial or paronychial flap. (C) Nail bed wounds were sutured with 5-0 Vicryl and 5-0 Nylon sutures.

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  Fig. 2. (A) A patient of 58-year-old man sustained a punch injury at a left index finger tip. (B) The radiographic image of the patient shows a fracture with a partial bone defect of the distal phalanx. (C) Reconstruction with a perionychial flap. (D) Postoperative 12 months view.

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  Fig. 3. (A) A patient of 56-year-old man suffered from crushing injury at right thumb. (B) The radiographic image of the patient shows a comminuted fracture of the distal phalanx. (C) Reconstruction with a perionychial flap. (D) Postoperative 10 months view.

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