Arch Plast Surg.  2022 Jan;49(1):70-75. 10.5999/aps.2021.01200.

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

• Koh SH
• Park I
• Kim JS
• Lee DC
• Roh SY
• Lee KJ
• Hong MK

• KMID: 2524919
• DOI: http://doi.org/10.5999/aps.2021.01200

Abstract

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.

Keyword

Finger injuries / Nails / Surgical flap