Abstract
Background and Objectives: Nail bed and germinal matrix loss due to wide excision for fingertip tumors or malignancy are occasionally encountered complications. These defects also result from severely comminuted fingertip crush injuries. Large-area dorsal finger or toenail bed defects, which usually present with phalangeal bone exposure, remain challenging regardless of the usage of different reconstruction strategies. This study aimed to evaluate the clinical outcome of a staged operation with an acellular dermal matrix coverage and subsequent skin graft as reconstruction for defects of total nail bed, germinal matrix loss, and bone exposure. Materials and Methods: From April 2018 to October 2019, four patients with total nail bed, germinal matrix, and bone exposure loss after surgery were enrolled in our series. A staged operation of the acellular dermal matrix coverage with subsequent skin graft was performed on these patients. Skin graft take rate, oncological prognosis, and cosmetic outcome were evaluated. Patients were followed up for 5–13 months. An excellent skin graft take rate with a satisfying aesthetic result without local malignancy recurrence was noted. Minimal functional deficit and donor site morbidity were reported. Results: A staged operation with acellular dermal matrix coverage and subsequent skin graft proves to serve as a feasible strategy for patients who experience total nail bed, germinal matrix loss, and bone exposure after surgery. Conclusions: This reconstruction method provides a reliable repair result, satisfying aesthetic outcomes, as well as having minimal functional deficits and donor site morbidity.
Highlights
Defects that result from total nail bed and germinal matrix removal are occasionally encountered in patients with digit malignancy who had undergone local wide excision
Local wide excision for digital malignancy often results in total nail bed and germinal matrix loss with large area of distal phalanx exposure
To focus more on total nail bed loss of surgical removal or avulsion nail bed injury, the challenge for reconstruction lies in how the defects are located on the dorsal aspect where there is a lack of soft tissue and that can often be accompanied by large areas of phalangeal bone exposure
Summary
Defects that result from total nail bed and germinal matrix removal are occasionally encountered in patients with digit malignancy who had undergone local wide excision. This type of defect is seen in patients with severe crush and comminuted nail bed injuries. The demographic data, surgical details, and clinical results were reviewed to evaluate the clinical outcome of a staged operation with acellular dermal matrix coverage and subsequent skin graft for reconstruction of defects of total nail bed and germinal matrix loss with bone exposure. This study aimed to evaluate the clinical outcome of a staged operation with an acellular dermal matrix coverage and subsequent skin graft as reconstruction for defects of total nail bed, germinal matrix loss, and bone exposure. An excellent skin graft take rate with a satisfying aesthetic result without local malignancy recurrence was noted
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