Reconstruction of complex nail matrix defect using the homodigital reverse fasciocutaneous flap

Abstract

Reconstruction of complex and severe nail matrix defects with the exposure of bone, tendon or joint continues to be challenging for the surgeon. We present our experience using the homodigital reverse laterodorsal fasciocutaneous flap in the reconstruction of complex nail matrix defects.Six patients (7 fingers) of complex nail matrix defects with the exposure of bone, tendon or joint were treated with the homodigital reverse laterodorsal fasciocutaneous flap based on the dorsal branches of the proper digital artery. In this study, the composite tissue defect size ranged from 1.0 × 1.5 cm2 to 1.3 × 2.5 cm2. All 6 patients participated in follow-up.All flaps survived well, and no complications were found postoperatively. The mean size of the flaps was 1.4 × 2.4 cm2 (range, 1.2 × 2.0–1.5 × 3.0 cm2); the mean follow-up period was 8 months (range, 4–15 months); patients’ average time to get back to their former jobs was 4.3 weeks (range, 3–6 weeks) postoperatively. All patients were satisfied with the appearance and functional outcomes of the fingers.The homodigital reverse laterodorsal fasciocutaneous flap based on the dorsal branches of the proper digital artery is an ideal surgical method to reconstruct the complex and severe nail matrix defect.

Homodigital Pedicled Digital Artery Perforator flaps for fingertip reconstruction - a review of flap options

“…Lateral perforators 15 (14M:1F) / 15 29.27 +/- 10.12 9 IF, 4 MF, 1 RF, 1 LF 15 IDAP IDAP: DIP flex 84 (+/- 9.67) | ext full 4.87 +/- 1.88 11.8 +/- 8.75 Quick dash (17.26 +/- 12.66) 5.73 +/- 2.25 wks All survived, marginal necrosis 1 (re-inset with complete survival); neuropathic pain 1; transient venous cong 3. 0 2018 Liu et al 26 DAP propeller / transposition, (reverse latrodorsal) FTSG to donor site 6(6M) / 7 37.7(23-50) 4 Saw, 2 crush 5MF,2RF 14 × 24 (12 × 20 to15 × 30) 7 DAP propeller / transposition DIPJ, PIPJ same as opposite side 8(4-15) 4.3(3-6) No complications 2018 Losco et al 23 DADAP, Reverse single pedicle (DIPJ) adipofascial flap with silver dressings for healing by II O intention (17-21 days) 14(12M:2F) / 15 44 (22-63) 15 Sharp 5IF,5MF, 4RF,1LF 18 × 20 15 DADAP DIPJ 71(65-80) PIPJ 89(80-100) 4.5(3-8) 12 Quick dash2.6(0-9.1) VAS pain0.7(0-4) Aesthetic - 1fair, 2 good, excellent 12 4.4 (4-5) All survived, 1 partial flap necrosis, 1 prolonged healing epithelialisation (32 days) 2019 Matei et al 17 DAP. Lateral perforators.…”

The Clinical Effect of Digital Dorsal Fascial Island Flap Combined With Crossfinger Flap for Repairing Distal Degloving Injury and Sensory Reconstruction

“…At present, the digital dorsal fascial island flap has been widely used to repair the soft tissue defect of the dorsal or ventral finger ( 7 – 10 ). The crossfinger flap can repair the soft tissue defect of finger palmar and reconstruct the flap sensation, and it has the advantages of simple operation and low-operation risk ( 11 , 12 ).…”

“…Free toenail flap transplantation is a difficult operation with high risk, great damage to patients, and high requirements for surgeons (2)(3)(4)(5)(6). At present, the digital dorsal fascial island flap has been widely used to repair the soft tissue defect of the dorsal or ventral finger (7)(8)(9)(10). The crossfinger flap can repair the soft tissue defect of finger palmar and reconstruct the flap sensation, and it has the advantages of simple operation and low-operation risk (11,12).…”

Nail matrix regenerative engineering: in vitro evaluation of poly(lactide‐co‐glycolide)/gelatin fibrous substrates

“…Following injury, the regrown nail may not possess the functionality and aesthetic appearance of the nail pre‐injury (Shieh & Cheng, ). While there is an option for surgical intervention, corrective surgeries may result in undesirable outcomes including poor cosmesis and impaired sensation at the fingertip (Liu et al, ). The recovery process is uncertain and may encompass weeks to months based on injury severity and patient responsibilities often necessitate an expeditious recovery.…”

“…While the fingernail contributes to the aesthetic appearance of the hand, the nail also protects the underlying nail bed and can be an indicator of systemic illness (Singal & Arora, 2015). Injuries to the nail may result in uncertain prognoses (Liu, Li, Li, Zhang, & Lu, 2018;Lorea, 2013;Shieh & Cheng, 2015), and injury severity further complicates the scenario. Following injury, the regrown nail may not possess the functionality and aesthetic appearance of the nail pre-injury (Shieh & Cheng, 2015).…”