Surgical Treatment of Fingertip Defects Associated With Nail Bed Injuries

Purpose To analyze the aesthetic and functional results of a dual-flap reconstruction protocol for nail expansion by recessing the nail fold to increase the exposed nail matrix after repair of finger pulp defect. Methods A total of 18 patients who underwent a dual-flap reconstruction protocol were retrospectively reviewed. We increased nail bed exposure by recessing a Y-V flap of eponychium and reconstructed the pulp with volar V-Y advancement flaps or homodigital island flaps depending on the injury geometry. A controllable 0.3- to 0.45-cm-wide recession of eponychium was feasible. The eponychial Y-V recession flap was separated from the nail matrix and slid proximally to expose more nail matrix, thereby effectively lengthening the exposed nail bed. Results The flaps survived in all patients. The exposed nail beds were lengthened 0.3 to 0.45 cm. The fingertips had smooth and natural nail plates with inconspicuous scars on both the eponychium and pulp and no deformities. The mobility of injured and uninjured contralateral fingers did not differ statistically. All patients and observers were satisfied with the appearance and function of the reconstructed fingertips. Conclusions The eponychial Y-V recession flap combined with volar soft tissue reconstruction provided for the aesthetic and functional restoration of the fingertip defects with partial nail bed defect.