gms | German Medical Science

Objectives/Interrogation: Controversy still exists as to the regenerative potential of the nailbed after trauma, with some recent evidence in rodent models pointing to the interplay between periosteal osteogenic cells and epidermis as potential contributors. In this context, we present a review of 31 patients with Allen type 2 to 4 fingertip injuries who underwent surgery using either an island or Atasoy flap.

Methods: We performed a retrospective chart review of 31 patients who sustained fingertip trauma with nailbed injury. Variables analyzed were age, type of injury (Allen classification), follow-up period, time from trauma to surgery and affected finger(s). Outcomes were evaluated based on presence and degree of tissue necrosis (1 - absent, 2 - less than 50%, 3 - greater than 50%), nail deformity (classified using the Result Reconstructed Fingertip Length Appearance of Nail Unit - and joint mobility. Mobility was evaluated in comparison to the contralateral (CL) phalange and classified as 1 - 100% CL, 2 - 75% CL, 3 - 50% CL, 4 - 25% CL.

Results and Conclusions: Complete data were available for all 31 patients. Most (21) had a crush injury, while four presented with a laceration. Injuries were classified as Allen types 2 (9), 3 (8) and 4 (14). Mean patient follow-up was 26 months

Nine patients, all of which had Allen type 2 crush injuries, underwent reconstruction with an Atasoy flap. None presented with postoperative necrosis. Regarding nail appearance, four was considered ''excellent' while six were classified as ''good''. Joint mobility was 100% CL in two patients, 99-75% in another two and 74-50% in one patient.

The 22 remaining patients with Allen types 2 (4), 3 (7) and 4 (11) injuries underwent reconstruction with an island flap. One patient with an Allen type 4 crush injury developed postoperative tissue necrosis, compromising less than 50% of the affected fingertip.

In total, one patient developed partial tissue necrosis, none developed necrosis greater than 50% of the tissue area, five had ''good'', rather than ''excellent'' nail appearance and four had decreased joint mobility compared to the contralateral finger.

Nailbed injury continues to be a relatively underappreciated topic of hand surgery, as many patients who sustain trauma or other injuries to the nails do not seek out medical help, and there is currently no consensus as to the optimal treatment of such injuries.