Functional and aesthetic outcomes of the fingertips after nail lengthening using the eponychial flap

Abstract

Eponychial flap technique is able to lengthen the visible nail and allow the preservation of the nail complex following fingertip amputations with nail bed involvement. The study assessed the functional and aesthetic outcomes of the reconstructed fingertips using the eponychial flap. Eponychial flaps were performed in 11 fingertip amputations. Two-point discrimination, light touch, Purdue dexterity test, and pinch power of the reconstructed digits were examined. Patient-reported outcomes including subjective pain, Michigan Hand Outcome Questionnaire, and visual analog scale for appearance were documented. For comparison, nine patients with similar fingertip amputations treated by stump revision and nail bed ablation were included. The average length of the visible nail beds of the injured digits was 33.3% compared with the contralateral normal nail beds. The eponychial flap could lengthen the nail beds by an average of 32.4% of the length of the contralateral side. The mean follow-up was 26 months. Patients treated using the eponychial flap had greater pinch power of the reconstructed digits, higher satisfaction, and better aesthetic results when compared with patients receiving stump revision and nail bed ablation. There were no significant differences between two groups in sensation and Purdue dexterity test. Patient satisfaction was correlated with the reconstructed nail length. The eponychial flap is a simple and safe technique that can restore the functional and aesthetic fingertip in selected distal phalanx amputations. The aesthetics, pinch power, and patient satisfaction are significantly better with fingernail preservation and elongation using the eponychial flap.