[Repair of severe nail bed defects with radial dorsal fasciocutaneous flap of thumb]

Yujie Liu, Xiaohen Ding, Hongsheng Jiao, Hongxun Zhang, Zhigang Qu, Kai Jiang, Xuecheng Cao
Chinese Journal of Reparative and Reconstructive Surgery 2013, 27 (5): 603-5

OBJECTIVE: To summarize the effectiveness of radial dorsal fasciocutaneous flap of thumb for repairing severe nail bed defects.

METHODS: Between May 2009 and January 2012, 16 patients with severe nail bed defect were treated with radial dorsal fasciocutaneous flap of the thumb. There were 10 males and 6 females, aged 16-54 years (mean, 36 years). The causes of injury included crush injury in 10 cases, chainsaw injury in 4 cases, and scald in 2 cases; injured fingers were thumb in 3 cases, index finger in 4 cases, middle finger in 5 cases, ring finger in 3 cases, and little finger in 1 case. The time between injury and operation was 2 hours to 8 days (mean, 19.3 hours). Of 16 patients, 9 complicated by distal phalanx fracture. The area of defect ranged from 0.9 cm x 0.6 cm to 2.3 cm x 2.1 cm. According to ZHOU Qingwen's grading system for nail bed defects, 6 cases were rated as degree III and 10 cases as degree IV. The area of flap ranged from 1.0 cm x 0.6 cm to 2.5 cm x 2.2 cm. Retrograde transposition was performed to repair the thumb defect, and pedicled transposition to repair the 2nd-5th fingers defects. The donor sites were directly sutured or were repaired with skin graft.

RESULTS: All flaps and skin grafts survived, and wounds healed by first intention. All patients were followed up 6-12 months (mean, 8 months). The color, texture, and contour of the flaps were good. According to total active motion standard, the finger function was assessed as excellent in 10 cases, good in 4 cases, and fair in 2 cases, and the excellent and good rate was 87.5%.

CONCLUSION: Radial dorsal fasciocutaneous flap of thumb is a reliable flap with easy dissection and less trauma in repair of severe nail bed defects.

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