Régénération du lit unguéal des patients pédiatriques

Abstract

Patients with fingertip and fingernail loss are often very self-conscious and tend to hide them, and, since fingernails are often dismissed as having very little functional value, patients often do not seek out assistance for reconstruction. We present a review of 21 patients, average age was 6 years [3–10 y]. Due to trauma between 2010 to 2016. With Allen type 2-4 fingertip injuries, who underwent surgery using either an island direct or Atasoy flap. Outcomes were evaluated based on presence and degree of tissue necrosis (1–absent, 2–less than 50%, 3–greater than 50%), nail deformity (classified using the Result Reconstructed Fingertip Length Appearance of Nail Unit). Mobility was evaluated in comparison to the contralateral (CL) phalange and classified as 1–100% CL, 2–75% CL, 3–50% CL, 4–25% CL. Injuries were classified as Allen types 2 (6), 3 (5) and 4 (10). Mean patient follow-up was 21 months [12–35 mo]. Five patients (23.8%), all of which had Allen type 2 crush injuries, underwent reconstruction with an Atasoy flap. Regarding nail appearance, one (20%) was considered “excellent” while four (80%) were classified as “good”. Joint mobility was 100% CL in two patients (40%), 99–75% in another two (40%) and 74–50% in one patient (20%). The 16 remaining patients (76.2%) with Allen types 2 (1), 3 (5) and 4 (10) injuries underwent reconstruction with an island flap. In total, one (4,7%) patient developed partial tissue necrosis, 5 (23%) had “good”, rather than “excellent” nail appearance and 4 (19%) had decreased joint mobility compared to the contralateral finger. For years, it was believed that the nail was produced by the germinal matrix only. Johnson et al. (1991) attempted to put an end to the discussion, stating that nail formation happens continuously throughout the nail bed, and not only in the germinal matrix. Ogo (1987) also observed that the nail bed is capable of regeneration. He noted that the best results were associated with and adequate nail matrix size, whereas nail matrices of inadequate size did not show good nail bed growth. Nail bed injury continues to be a relatively under-appreciated topic of hand surgery and there is currently no consensus as to the optimal treatment of such injuries. Our study shows that the Atasoy and island flaps are excellent options for pediatric nail bed injuries.