gms | German Medical Science

Objectives/Interrogation: Nailbed trauma is a commonly overlooked part of fingertip reconstruction. To evaluate outcomes of nailbed injuries treated with different reconstructive techniques, we performed a retrospective review of 76 patients who presented with nailbed injuries.

Methods: We conducted a retrospective chart review of 76 adult and pediatric patients who underwent nailbed reconstructions due to trauma between January 2000 and August 2017 at our institution's division of Hand Surgery and Reconstructive Microsurgery; only patients with at least 12 months of follow-up were included.

Outcomes assessed were growth (0 = no growth; 1 = partial growth; 2 = normal growth), size (0 = less than 25%; 1 = between 25 and 50% and 2 = >50% of the size of the contralateral nail) and shape (0 = significant deformity on the horizontal and vertical planes; 1 = vertical deformity, 2 = no deformity) of the nail compared to the contralateral finger. The results obtained by the sum of scores were classified as good (5-6), acceptable (3-4) and poor as previously described by Foucher et al.

This study was approved by our institution's institutional review board for ethics in research and performed in accordance with the Declaration of Helsinki.

Results and Conclusions: In our series, 32 patients (42.10%) underwent suturing of the nailbed (SNB); 25 patients (32.89%) underwent suturing of the nailbed associated with an osteosynthesis of the distal phalanx (SNBOst); 19 (25%) received a nailbed graft in the ER (NBGE) (Table 2).

The results were considered ''good'' in all patients who underwent SNB and in those who underwent SNBOst associated with an osteosynthesis of the distal phalanx. ''Good'' results were also achieved in 57.9% of patients who underwent NBGE.

''Acceptable'' results were obtained in 42.1% of patients grafted in the ER.

In summary, in our series, patients treated with simple suturing of the nailbed - both those with and without associated finger fractures - and patients who underwent reconstruction of the entire nailbed showed improved outcomes compared to those treated with nailbed grafts. Larger prospective, randomized trials stratified by degree of injury may help guide the most appropriate approach to patients with these challenging injuries.