Preservation Techniques in Fingertip Reconstruction

Abstract and Introduction

Abstract

Background: The goals of fingertip reconstruction are to achieve adequate soft-tissue coverage and a functional nail plate and to maintain sensation, proprioception, and cosmesis.

Objective: We present a composite tissue graft and volar V-Y advancement flap for reconstruction of a traumatic amputation of a fingertip, which provided optimal preservation of the hyponychium and the volar pad for prevention of a hook nail. Historically, composite fingertip grafts have not been recommended for adults with large defects.

Methods: The amputated nail bed, hyponychium, and a 10 × 20-mm segment of the fingertip were utilized as a composite graft for reconstruction of the nail bed in an adult. The addition of a volar V-Y advancement flap to reconstruct the fingertip was necessary for complete soft-tissue reconstruction.

Results: The reconstruction resulted in nail plate adhesion without significant nail deformity and a functional and sensate fingertip.

Conclusion: Components of amputated fingertips including the sterile matrix, hyponychium, and part of the fingertip can be utilized in a composite graft to yield satisfactory functional and cosmetic results in adults.

Introduction

The goals of fingertip reconstruction are to achieve adequate soft-tissue coverage and a functional nail plate and to maintain sensation, proprioception, and cosmesis. The technique selected typically depends on the extent of the injury and experience of the surgeon. Skin grafts, local flaps, and open healing can suffice for less severe injuries, but injuries that result in significant nail bed and pulp deficits require advancement flaps or even distant flaps.^[1] Optimal aesthetic appearance may not be achieved with these flaps because of hyponychial tissue loss and subsequent absence of the volar support of the nail plate. Historically, composite fingertip grafts have not been recommended for adults with large defects, as revascularization was thought to be unreliable.^[2–5] In adults with transverse or dorsal oblique planes of fingertip amputation, a composite nail bed graft that includes the sterile matrix, hyponychium, and part of the fingertip can be utilized with a volar V-Y advancement flap to provide functional reconstruction with improved cosmetic results.