The post-traumatic reconstruction of nail bed defects using a homodigital dorsal adipofascial reverse flap

Abstract

Nail bed defects (NBDs) of the distal phalanx, are common and remain challenging to reconstruct. This study aimed to evaluate the clinical outcome of these post-traumatic injuries treated using a homodigital dorsal adipofascial reverse flap (HDARF). Sixteen patients, averaging 43-years-old, were retrospectively reviewed, who underwent the aforementioned procedure from February 2018 to December 2019. Range of motion of the distal interphalangeal (DIP) joint, static Weber’s 2-point discrimination sensibility of the pulp, the percentage of nail adherence, complications, patient’s satisfaction, subsequent nail regrowth, and flap survival were evaluated upon follow-up. At 26 months average follow-up, the percentage of flap survival was 100%. Complete regrowth of the nail was reported in 11 cases (69%), on average 4.7 months after surgery. A total absence of ungual regrowth was noted in 5 cases (31%). The mean static Weber’s 2-point discrimination value of injured finger was 4.25 mm, reconstructed fingers’ mean range of motion for the DIP joint was 75 degrees. Patient satisfaction was graded as very satisfying in 11 cases (69%), satisfying in 4 cases (25%), and disappointing in 1 case (6%). The HDARF is a good alternative for the management of NBDs of fingers and thumb. It yielded functionally and aesthetically acceptable results with low donor site morbidity. Level of evidenceIV.