J Korean Soc Surg Hand.  2017 Mar;22(1):27-33. 10.12790/jkssh.2017.22.1.27.

Immediate Nail Lengthening with the Eponychial Folding Procedure in Acute Finger Tip Injury

• Kang DH
• Nam HJ
• Cheon HJ
• Kim YW
• Woo SH

• KMID: 2375464
• DOI: http://doi.org/10.12790/jkssh.2017.22.1.27

Abstract

PURPOSE
We present the clinical results and operative method of the immediate eponychium of nail fold set back for lengthening of nails caused by acute fingertip injuries.
METHODS
The research was conducted with a total of 172 patients during the period from January 2014 to June 2016. The operation method was performed in a way to fold down the two sides of the nail eponychium and had suture. A survey of the patients' subjective satisfaction was conducted and the relative nail length was compared before and after the operation as well as the nail length of the uninjured contralateral finger. The mean follow-up period was 18.2 weeks.
RESULTS
In all cases, the operation time was under 3 minutes. There were no specific complications such as nail eponychium's necrosis or congestion. The new nail did not have any additional deformation. On average, the extended nail length was 3.2 mm. Compared with preoperation, the average extension ratio of the nail length was 48%, even with 75% of nail length recovery in comparison with the uninjured contralateral finger. The subjective self-satisfaction score was 92.5 on average. The satisfaction score was higher for patients who had greater remnant nail length.
CONCLUSION
Immediate nail lengthening with the eponychial folding is a simple, safe and useful method with high subjective satisfaction in aesthetics for the patients with acute fingertip injuries.

Keyword

Immediate nail lengthening; Acute fingertip injury; Folding of eponychium

MeSH Terms

Esthetics
Estrogens, Conjugated (USP)
Fingers*
Follow-Up Studies
Humans
Methods
Necrosis
Sutures
Estrogens, Conjugated (USP)

Figure

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  Fig. 1 Surgical procedure. (A) The longitudinal incision of both sides of the eponychium as wide as the residual nail width. (B) In a way folding of the eponychium and fixation with half-buried horizontal mattress sutures. (C) Postoperative view of immediate nail lengthening.

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  Fig. 2 Measurement of extended nail length.

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  Fig. 3 (A) A 53-year-old man had a crush injury of the right index fingertip. (B, C) The thenar flap covers pulp defect of the fingertip and nail lengthening with eponychial flooding carried out immediately. (D) Postoperative view about 20 weeks later; satisfaction of the new nail was very high regarding the shape and length of the injured nail.

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  Fig. 4 (A) A 55-year-old man had a crush injury of the right long and ring fingertip. (B, C) The volar V-Y advanced local flap covers the fingertip defect and nail lengthening with eponychial flooding carried out immediately. (D) Postoperative view about 24 weeks later. Excellent nail figure and length compared with an uninjured contralateral nail.

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  Fig. 5 (A) A 43-year-old woman suffered a guillotine amputation of the left ring fingertip. (B, C) The cross finger flap covers the finger tip defect and nail lengthening with eponychial flooding carried out immediately. (D) Postoperative view about 20 weeks later. The excellent nail figure and length compared with an uninjured contralateral nail.

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