The Use of Composite Bone and Nail Bed Graft Combined with Cutaneous Flaps for Reconstruction of Fingertip Amputations | ||
| The Egyptian Journal of Plastic and Reconstructive Surgery | ||
| Article 12, Volume 49, Issue 3, July 2025, Pages 257-261 PDF (711.58 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejprs.2025.444138 | ||
| Authors | ||
| Hassan A Hamid* ; Ahmed Salah Mazeed; Gamal Youssef El Sayed; Samia M A Saied | ||
| The Department of Plastic Surgery, Sohag Faculty of Medicine, Sohag University | ||
| Abstract | ||
| Background: The approach of using a composite graft consisting of bone and nail bed from the amputated part, along with a local skin flap, may offer a promising solution for managing fresh fingertip amputations to preserve its length and restore its shape. Objectives: This study aimed to evaluate the effectiveness of combining composite bone and nail bed grafts with different local skin flaps for fingertip reconstruction. Patients and Methods: This clinical study prospectively examined 16 patients, with an age ranging from 5 to 65 years, of both sexes, who had fingertip amputations at any level through the nail bed and distal phalanx, with the amputated part preserved. Results: The Flap used was cross finger in 15 patients (93.25%), and V-Y flap in 1 patient (6.75%). Flap viability was viable in 13 patients (81.25%), partial loss in 2 patients (12.5%) and flap loss in 1 patient. Nail bed survival was viable in 6 patients (37.5%), partial loss in 5 patients (31.25%), and total loss in 5 patients (31.25%). Bone graft survived in 12 patients (75%), partial loss in 2 patients (12.5%) and total loss in 2 patients (12.5%). Bone union was united in 12 patients (85.71%), and ununited in 2 patients (14.29%). Conclusions: The use of bone and nail bed as composite grafts combined with local and regional cutaneous flaps can effectively salvage fingertip amputations, particularly in patients where replantation is not feasible. Despite most favorable outcomes regarding flap viability and bone union, there were notable instances of nail bed loss. | ||
| Keywords | ||
| Composite Bone; Nail Bed Graft; Cutaneous Flaps; Reconstruction; Fingertip Amputations | ||
| References | ||
|
1- Karakas A.O. and Yuce E.: Evaluation of pediatric fingertip injuries using etiology, demographics and therapy. Skin Append Disord., 54: 306-40, 2020. 2- Masaki S. and Kawamoto T.: Fingertip amputation injury of allen type III managed conservatively with moist wound dressings. Am. J. Case Rep., 22: 40-12, 2021. 3- Deivasigamani S., Gundlach B. and Strohl A.: Fingertip Injuries. Hand Surg. 20. 2nd ed: Springer, p. 317-46, 2023. 4- Haneke E.: Foot, toe and nail changes are they interdependent. Skin Append Disord., 12: 700-50, 2024. 5- Queirós C., Garrido P.M., Fraga A., Maia-Silva J. and Filipe P.: Nail surgery: General principles, fundamental techniques, and practical applications. J. Cutan Aesthet. Surg., 15: 341-54, 2022. 6- Cvrtak S.: Reconstructive microsurgery: University of Rijeka. Faculty of Medicine. Department of Surgery. 2024. 7- Satku M., Puhaindran M.E. and Chong A.K.: Characteristics of fingertip injuries in children in singapore. Hand Surg., 20: 410-4, 2015. 8- Zhou X., Wang L., Mi J., Xu Y., Rui Y., Xue M., et al.: Thumb fingertip reconstruction with palmar V-Y flaps combined with bone and nail bed grafts following amputation. Arch. Orthop. Trauma Surg., 135: 589-94, 2015. 9- Malshikare V.A.: Graft reposition on flap: Mid-term result in allen type IV amputation. J. Hand Surg. Asian Pac., Vol. 24: 219-23, 2019. 10- Han D., Sun H., Jin Y., Wei J. and Li Q.: A technique for the non-microsurgical reconstruction of thumb tip amputations. J. Plast. Reconstr. Aes. Surg., 66: 973-7, 2013. 11- Dubert T., Houimli S., Valenti P. and Dinh A.: Very distal finger amputations: Replantation or “reposition-flap” repair? J. Hand Surg Br., 22: 353-8, 1997. 12- Alagoz M.S., Uysal C.A., Kerem M. and Sensoz O.: Reverse homodigital artery flap coverage for bone and nailbed grafts in fingertip amputations. Ann. Plast. Surg., 56: 279-83, 2006. 13- Shawer O.H., AbdelHalim M.M., Badawy M.S., Harfoush A., Elmenoufy T. and El Badawy A.: Allen’s based algorithm for management of fingertip injuries in EL Helmya Armed Forces Hospital. Arc. Med., 10: 101-7, 2023 | ||
|
Statistics Article View: 71 PDF Download: 63 |
||
