Long-term follow up of the nails of the thumbs reconstructed with the wrap-around flap.

Abstract

Objective To investigate the long-term changes of the nails of the thumbs reconstructed with free wrap-around flap. Methods Patients who underwent thumb reconstruction with wrap-around flap were followed up. The nails of the reconstructed thumbs were examined, and their widths and lengths were measured and compared with those of the uninjured thumbs and the contralateral intact big toes. Results A total of 19 cases were followed up for an average period of 40 months （range 7 to 182 months）. None of the nail beds was trimmed during the surgery. Although all the nails of the reconstructed thumbs had good appearance without any deformity, most of them decreased in both width and length with increased curvatures. The average nail bed width of the reconstructed thumbs （17.1±2.3 ）mm decreased compared with that of the intact big toes （19.3±2.4）mm, and the difference was statistically significant （t =5. 95,P 〈0.01）. The difference of the average nail bed width between the reconstructed and the uninjured thumbs （ 17.1±1.7） ram was not statistically significant（t=0.00,P〉0.05） , but the nails of the reconstructed thumbs had increased curvature, which created an impression that they were narrower than those of the uninjured ones. The average nail bed length of the reconstructed thumbs （12.2±2.2） mm decreased more significantly, and it was smaller than those of the inter big toes （14.7±2.4） nun and the uninjured thumbs （15.4±3.2 ） mm, both with statistical significance （t=5.72, P 〈0.01 and t = 4. 27, P 〈0. 01 respectively）. The nail beds of the reconstructed thumbs with the degloved thumb phalanges as the underlying bones were neither longer nor wider than those with the iliac crest as the underlying bones. Conclusion The nails of the thumbs reconstructed with wrap-around flap would become remarkably atrophic both in width and length postoperatively. In addition they look smaller than those of the uninjured thumbs due to their increased curvatures, so it was not necessary to trim the transferred nail beds intraoperatively. Key words: Nails; Surgical flap; Nail bed ; Thumb reconstruction