Effect of plastic repair of fingertip injury with equivalent design mini toenail flap
Li Xiuzhong1, Yu Dazhi1, Zhang Huagang1, Fan Xiao2, Xue Zichao2, Lao Kecheng2
1Military Hand Surgery Center, the No.971 Hospital of the People's Liberation Army Navy, Qingdao 266071, China; 2Department of Trauma Surgery, Qingdao Municipal Hospital, Qingdao 266011, China
Abstract：Objective This study aims to explore the clinical effect of plastic repair of fingertip injury with equivalent mini toenail flap. Methods This case series report with retrospective analysis was conducted on 56 patients (56 fingers) with fingertip injuries treated with equivalent design mini toenail flaps for plastic repair at the No. 971 Hospital of the People's Liberation Arm and Qingdao Municipal Hospital from May 2015 to May 2020. The patients included 36 males and 20 females, aged 30-50 (40.2±5.4) years. Twenty patients had thumb fingertip damage, 17 patients had index fingertip damage, 10 patients had middle fingertip damage, and 9 patients had ring fingertip damage. Moreover, 36 patients had door crush injury and 20 patients had machine crush injury. Fingertip soft tissue defects ranged from 0.60 cm×1.00 cm to 0.80 cm×1.50 cm, and nail bed defects ranged from 0.40 cm×0.70 cm to 0.60 cm × 0.80 cm. The time from injury to operation was 2-7 (4.8±1.4) h. The size of the equivalently designed mini toenail flap was 0.71 cm×1.22 cm to 0.88 cm×1.71 cm. The operative conditions and postoperative complications were recorded and the survival rate of great nail flap was calculated. At the last follow-up, the appearance and texture of fingers were observed. Nail repair was evaluated according to Zook nail-bed repair evaluation criteria. Semmes-Weinstein touch pressure sense and two-point resolution sense were recorded. The trial criteria of upper limb partial function evaluation of the Hand Surgery Society of the Chinese Medical Association were used to evaluate the surgical effect. Results All patients underwent surgery smoothly, with a duration of 2-5 (3.5±0.6) h and intraoperative bleeding of 13-27 (20.7±4.9) mL. All 56 fingers survived, with a survival rate of 100%. One patient developed venous crisis 48 h after surgery, and two patients developed arterial crisis 13 h and 17 h after surgery. All patients survived after surgery. The postoperative follow-up was 20-45 (30.82±11.21) months, and the total nail growth time was 6-13 (9.68±2.11) months. At the last follow-up, 56 patients recovered nail growth, finger thread and fine sensation, no nail malformation, beautiful and realistic appearance, good skin flap shape and texture, and protective sensation. According to the Zook nail bed repair evaluation standard, 38 patients were excellent, 18 patients were good, and the excellent and good rate was 100%. The Semmes Weinstein tactile sense was 0.1-0.2 (0.32±0.14) g, and the two-point resolution angle was 5-9 (7.33±1.02) mm. According to the trial criteria of upper limb function evaluation of the Hand Surgery Society of the Chinese Medical Association, 46 patients were excellent, 10 patients were good, and the excellent and good rate was 100%. Conclusion The plastic repair of fingertip injury with equivalent mini toenail flap has little damage in the donor area, beautiful appearance, and good functional recovery; hence, it is an effective surgical method for the treatment of fingertip damages.
李秀忠, 于大志, 张华刚, 范筱, 薛子超, 劳克诚. 对等设计微型𧿹甲瓣整形性修复指尖毁损伤的疗效分析[J]. 中华解剖与临床杂志, 2024, 29(1): 43-47.
Li Xiuzhong, Yu Dazhi, Zhang Huagang, Fan Xiao, Xue Zichao, Lao Kecheng. Effect of plastic repair of fingertip injury with equivalent design mini toenail flap. Chinese Journal of Anatomy and Clinics, 2024, 29(1): 43-47.
Lan X, Huang Y, Guo L, et al.Treatment of fingertip defect with reversed digital artery island flap through superficial vein anastomosis[J]. ANZ J Surg, 2021,91(9):E584-E588. DOI: 10.1111/ans.16698
[2]
Hong MK, Park JH, Koh SH, et al.Microsurgical free tissue options for fingertip reconstruction[J]. Hand Clin, 2021,37(1):97-106. DOI: 10.1016/j.hcl.2020.09.002
[3]
Cui M, Wang P.Fingertip Reconstruction using a lateral flap based on the distal transverse arch of the digital artery[J]. Ann Plast Surg, 2020,84(5S Suppl 3):S186-S189. DOI: 10.1097/SAP.0000000000002370
[4]
郑晓飞, 江起庭, 胡小峰, 等. 携带穿支血管推进皮瓣在肢体软组织缺损创面修复中的应用[J].中华解剖与临床杂志,2020,25(6):695-697. DOI: 10.3760/cma.j.cn101202-20200118-00013 Zheng XF, Jiang QT, Hu XF, et al.Clinical application of advancement flap with major artery for repairing wounds in limbs[J]. Chin J Anat Clin,2020,25(6):695-697. DOI: 10.3760/cma.j.cn101202-20200118-00013
[5]
Yang J, Yu C, Jia X.A new surgical method to reconstruct the fingertip[J]. Ann Plast Surg, 2019,83(6):647-649. DOI: 10.1097/SAP.0000000000002002
[6]
Seo BF, Sohn WI, Jung SN.Reconstruction of fingertip defects with great toe pulp grafts: reply[J]. Ann Plast Surg, 2016,77(1):136-137. DOI: 10.1097/SAP.0000000000000843
[7]
Zook EG, Guy RJ, Russell RC.A study of nail bed injuries: causes, treatment, and prognosis[J]. J Hand Surg Am, 1984,9(2):247-252. DOI: 10.1016/s0363-5023(84)80153-7
[8]
Liu H, Hou R, Regmi S, et al.Comment on the sohn et al study, reconstruction of fingertip defects with great toe pulp grafts[J]. Ann Plast Surg, 2016,77(1):135-136. DOI: 10.1097/SAP.0000000000000842
刘刚义,张锦涛,杨伟超,等. 𧿹甲瓣与瓦合中指及环指相邻侧岛状皮瓣两种方式修复拇指末节脱套伤的疗效观察[J]. 中华显微外科杂志,2022,45(4):366-371. DOI:10.3760/cma.j.cn441206-20220108-00007 Liu GY, Zhang JT, Yang WC, et al.Effect of hallux toe nail flap and adjacent island flap of the middle and ring fingers in repair of degloving injury of distal thumb[J]. Chin J Microsurg, 2022,45(4):366-371. DOI: 10.3760/cma.j.cn441206-20220108-00007
[11]
刘胜哲, 巨积辉, 柳志锦, 等. 同蒂𧿹甲瓣和第2趾胫侧皮瓣瓦合修复拇指末节脱套伤长期随访一例[J].中华显微外科杂志,2021,44(2):234-236. DOI: 10.3760/cma.j.cn441206-20210114-00014 Liu SZ, Ju JH, Liu ZJ, et al.Long term follow-up of a degloving injury of distal thumb repaired with a combined wrap-around flap of hallux nail flap and tibial flap of the second toe: a case report[J]. Chin J Microsurg,2021,44(2):234-236. DOI: 10.3760/cma.j.cn441206-20210114-00014
[12]
周家顺. 以(𧿹)横动脉及趾底动脉为蒂的Flowthrough游离皮瓣修复指掌侧软组织缺损[J].实用手外科杂志,2022,36(2):148-151,160. DOI: 10.3969/j.issn.1671-2722.2022.02.004 Zhou JS.Application of flowthrough digitorum fibular free skin flap pedicled with thumb transverse artery and basal digitorum artery for repairing soft tissue defect on the palmar side of the fingers[J].Journal of Practical Hand Surgery,2022,36(2):148-151,160. DOI: 10.3969/j.issn.1671-2722.2022.02.004
[13]
Li M, Chen Z, Yang Y, et al. Split-thickness nail bed flap graft in the management of distal partial defect of the nail bed combined with soft tissue[J]. J Hand Surg Am, 2020,45(9):879.e1-879.e10. DOI: 10.1016/j.jhsa.2020.02.018
[14]
Gu JH, Choi SH, Yoon JH.Anylasis of nail bed injuries: cause, outcome, treatment[J]. Ann Plast Surg, 2021,87(2):156-160. DOI: 10.1097/SAP.0000000000002772
2024, Vol. 29 
