The Use of Composite Bone and Nail Bed Graft Combined with Cutaneous Flaps for Reconstruction of Fingertip Amputations

Document Type : Original Article

Authors

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

Main Subjects

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