Hook Nail Deformity Research Articles

Comparing clinical and aesthetic outcomes of cross-finger and homodigital reverse digital artery island flap for fingertip injuries: A single-center retrospective cohort study

BackgroundReverse homodigital artery island flap (RHDI) has reported some postoperative complications. Cross-finger reverse digital artery island flap (CRDI), which is harvested from an adjacent intact finger, has been performed to decrease these complications. This study aimed to provide a review of the CRDI procedure and to compare the clinical outcomes of CRDI with RHDI. MethodsRHDI has been performed for fingertip amputations with the deficit of 1.5–2.5cm before 2018, and CRDI has been performed since 2018. We assessed functional and aesthetic outcomes, including finger length, nail deformity, finger motion, and Hand20 scores at the final follow-up. ResultsWe identified 22 patients who underwent RHDI and ten patients who underwent CRDI. The mean follow-up period was 10.3 ± 5.3 months. The median time required for wound healing in RHDI was 47.0 days (IQR: 34.3–55.8), and that in CRDI was 34.5 days (IQR: 29.3–44.3). The hook nail deformity occurred significantly more frequently in RHDI compared to in CRDI (40.9% vs. 0.0%, p = 0.03). Flexion contracture of the proximal interphalangeal joint greater than 15º was found significantly more in RHDI than in CRDI (36.4% vs. 0,0%, p = 0.04). The median postoperative total active motion of the donor site in CRDI was 278º (IQR: 260º–280º). The median postoperative Hand20 scores were similar between the two groups. ConclusionCRDI was associated with superior clinical outcomes in terms of lower rate of postoperative flexion contracture and hook nail deformity, potentially making it a better option compared to RHDI.

Comment on “Comparing clinical and aesthetic outcomes of cross-finger and homodigital reverse digital artery island flap for fingertip injuries: A single-center retrospective study” and a focus on hook nail deformity

Comment on “Comparing clinical and aesthetic outcomes of cross-finger and homodigital reverse digital artery island flap for fingertip injuries: A single-center retrospective study” and a focus on hook nail deformity

V advancement eversion flap for fingertip injury: Preventing ischemia and hook-nail deformity

IntroductionTraumatic fingertip amputation is the most common type of upper extremity injuries. The V-Y advancement flap is a reliable method for reconstructing fingertip defects, but it is associated with complications such as hook-nail deformity and suture site ischemia. Here, we describe our modifications to V-Y advancement flap technique, termed as “V advancement eversion flap” and review the outcomes of this procedure in 21 patients with fingertip amputation. MethodsThis was a retrospective review of 21 consecutive patients with fingertip injury who were treated surgically using the V advancement eversion flap technique at a single trauma center between 2006 and 2019. We analyzed the age, injury location and mechanism, Allen classification, injury geometry, and objective and subjective clinical outcomes. ResultsTwenty-three fingertip amputations with defect sizes greater than 1.0 cm2 from the tip to lunula were included in this study. The mean age of the patients was 43.6 years (range, 24–65 years). The average follow-up period was 20 months (range, 12–37 months). The average wound healing time (apparent epithelization) was 29.4 days (range, 14-41 days). At the final follow-up, all flaps had healed uneventfully without noticeable hook-nail deformity. In the static two-point discrimination test, the mean value was 4.61 mm in the injured finger. Patient ratings of the outcomes were “excellent” in 18 and “good” in 5 cases. ConclusionThe V advancement eversion flap technique, when properly designed and executed in fingertip amputation cases, can minimize morbidity and result in successful wound healing without flap necrosis and hook-nail deformity.

Reverse dorsolateral proximal phalangeal island flap: Long-term results

ObjectivesThis study aims to present long-term follow-up results of the reverse dorsolateral proximal phalangeal island flap designed for reconstruction of large fingertip and pulp defects. MethodsWe examined 18 patients who underwent reverse dorsolateral proximal phalangeal island flap surgery to address ≥2.5 cm fingertip and pulp defects. Mean follow-up was 84.4 months. Sensitivity assessments were conducted using the Semmes–Weinstein monofilament and 2-point discrimination tests. Additionally, we evaluated finger joint active range of motion, complications and cold intolerance. ResultsMild venous congestion was observed in 5 flaps. Significant differences were observed in 2-point discrimination and Semmes-Weinstein monofilament tests between the injured and contralateral sides, specifically in the flaps, the dorsal side of the middle phalanx, and the donor site. The flap's mean static 2-point discrimination was 8.3 mm. Restricted distal interphalangeal joint extension was observed in 2 cases. Total active motion with the flap was good or excellent in the injured fingers, but with a significant difference between injured and contralateral fingers. Additionally, 42% of the injured fingers exhibited hook nail deformity, and 2 patients reported cold intolerance. Despite these issues, most patients has high scores for the appearance and satisfaction aspects of the Michigan Hand Outcomes Questionnaire. ConclusionIn moderate or larger fingertip defects, the reverse dorsolateral proximal phalangeal island flap serves as an alternative for reconstructing both fingertip and pulp issues. However, this option involves sacrificing some sensation in the dorsum of the middle phalangeal finger and the donor area. Level of evidenceIV, therapeutic study.

Hook nail deformity in a child – treatment option with bone graft and thenar flap. Case study with pros and cons

Introduction. Hook nail deformity is a common complication following fingertip amputations. Loss of distal bone support and palmar pulp tissue, results in the volar curving of the nailbed, which may cause pain, and aesthetic and functional problems. A few procedures have been described to address nail deformity, including flaps, skin and bone grafts, and microsurgical transfer. Unfortunately, none of the techniques provides reliably good and persistent correction. Case report. An 8-year-old boy sustained amputation of the distal phalanx of the middle finger and underwent surgical closure of the wound. After 4 years, the patient was admitted to our Department due to a deformed hook nail, which was aesthetically distressing. The hook nail was curved volarly and obliquely. The radiographs showed the lack of a significant part of the distal phalanx. Treatment. Surgical reconstruction of deficient distal phalanx was performed. The iliac bone graft, inserted into the distal phalanx, was stabilized with two K wires. A Pedicled flap of full-thickness from the thenar was used to cover skin loss over the fingertip. Pedicle division was performed at around 4 weeks. “K” wires were removed after 4 months. Results. The procedure was well-tolerated by the patient, and no complications occurred. Bone graft provided solid support for the nail bed during healing. Adequate growth and aesthetics of the hook nail were achieved. At 2 years follow-up, slight rotation of the nail was observed, which could have resulted from partial graft resorption and growth of the patient. The patient was satisfied with the treatment. Conclusions. Although perfect restoration of the nail bed length and pulp contour remains unobtainable, our result showed stable correction of the hook nail deformity.

Homodigital Unipedicled Islanded Neurovascular Pulp Advancement Flap/Colombo Flap for Fingertip Reconstruction: A Case Series with a Novel Technique.

Fingertip injury is the most common type of upper extremity injury. Operative treatment with flap cover is required for tissue loss causing bone exposure and when there is a compelling need to preserve the length, unless microvascular replantation is possible. There are many techniques described for this purpose offering varying degrees of good outcomes. Yet there are limitations and long-term problems. We report a case series with a novel technique named "Colombo flap," which is a neurovascular islanded advancement flap based on a single pedicle. Five fingers of four consented patients were operated using this technique and they were followed up for 2.5 years. All had satisfactory sensory recovery (S3 +/S4), preserved range of motion (ROM) at interphalangeal joints, good grip strengths, and satisfactory outcomes based on Michigan Hand Questionnaire (MHQ). There were no complications such as flap necrosis, infection, and neuroma formation. Hook nail deformity was minimal and none had pain or cold intolerance.

Semi-occlusive dressing versus surgery in fingertip injuries: A randomized controlled trial

ObjectivesNo gold-standard treatment has been established for the management of distal digital amputation in Ishikawa zones II and III. The objective of this study was to compare the results of management of fingertip amputation by semi-occlusive dressing versus surgery. The principal hypothesis was that a semi-occlusive dressing results in better recovery of sensory function than a digital flap. MethodsWe conducted a prospective, randomized, multicenter study of 44 patients: 23 managed conservatively with semi-occlusive dressing, and 21 surgically with digital flap. ResultsMean follow-up was 12 months. Mean healing time was 4.9 weeks in the semi-occlusive dressing group and 3.6 weeks in the surgery group. There was no significant difference between groups for sensory recovery of fine touch (p = 0.198) or 2-point discrimination (p = 0.961). No infections were reported in either group. Hook-nail deformity was more frequent in the semi-occlusive dressing group, particularly in case of amputation in zone III. ConclusionsSemi-occlusive dressing enabled satisfactory healing and sensitivity recovery without increasing the risk of infection. However, in zone III amputation, we advocate surgical treatment with a digital flap, due to poor trophicity and the frequency of hook-nail deformity seen with conservative management. Level of evidenceII.

Hook nail deformity correction by the combination of the antenna procedure and reverse-flow homodigital island flap: Description of clinical cases

BACKGROUND:Hook nail deformity is one of the widespread post-traumatic deformities of distal phalanges. The affected finger has decreased function and loses its characteristic appearance. Onlyafew publications explored this problem in children. In this study, we presentasurgical correction technique for this deformity by the combination of two existing reconstructive methods, i.e., the antenna procedure and the reverse-flow homodigital island flap.
 CLINICAL CASES:Aseries of clinical cases of patients aged 3, 5, and 17 years who underwent hook nail deformity correction was analyzed. These children underwent the combination of the antenna procedure and reverse-flow homodigital island flap. In all three cases, the deformities were corrected, andanacceptable appearance, and function of the fingers were achieved.
 DISCUSSION:Various methods of hook nail deformity correction have proven themselves and affirmed by literature data. The method described herein may be considered reliable, as demonstrated by the clinical cases.
 CONCLUSIONS:We consider the combination of the antenna procedure and reverse-flow homodigital island flap asajustified method. However, issues raised in this technique require further investigation.

Long-term patient-reported outcome measures of fingertip coverage with a homodigital unipedicle neurovascular island flap.

We report the long-term patient-reported outcomes and objective outcomes of a homodigital neurovascular island flap for distal phalangeal amputations in the fingers (with the thumb excluded) for 20 patients at a median follow-up of 4.4 years (IQR 2.2 to 12.3). We assessed the global subjective and aesthetic outcomes, range of motion, sensitivity and strength. The patient-reported median subjective global score was 7.5/10 points (IQR 7 to 9) and the aesthetic score was 8/10 points (IQR 8 to 9). Range of motion, sensitivity and strength were similar to the uninjured side. Stiffness was present in more than half of the cases; 14 patients had a hook nail deformity and seven patients reported symptomatic cold intolerance. At a long-term follow-up, the patient-reported outcome measures and objective outcomes of this flap are satisfactory and it is a safe and reliable flap.Level of evidence: IV.

Modified Bilateral V-Y Rotation Advancement Flap for Coverage of Fingertip Amputations.

Background: The use of homodigital antegrade flow flaps is an appealing option for coverage of fingertip injuries with exposed bone as it provides good padding, sensation and colour match with no need for splinting or secondary procedure for flap separation. V-Y flaps presented by Atasoy and Kutler have limited ability of distal advancement. We used two separate V flaps each based on a separate neuro-vascular bundle to allow better advancement while keeping good vascularity and sensation. Methods: We used a modified bilateral V-Y rotation advancement flap for coverage of fourteen fingertip injuries with bone exposed in 11 adult patients. Time to complete healing and return to work was recorded. Range of motion of injured finger as well as fingertip sensation using two-point discrimination were assessed and compared to non-injured contralateral finger 6 months after surgery. Fingertip hypersensitivity, cold intolerance and hooked nail deformity were assessed as well. Results: All flaps survived, and all patients resumed their activities after a mean period of 5 weeks. The mean two-point discrimination was 3.9 mm and was comparable to non-injured side. All patients regained full range of motion and were satisfied by the result. Two cases suffered from hypersensitivity that resolved at 3 months post-operative. Hooked nail deformity and cold intolerance were not recorded in our study. Conclusions: This modified bilateral V-Y rotation advancement flap technique presents a simple and single step procedure that provides good padding of fingertip with cosmetically pleasant contour and normal sensation. Level of Evidence: Level IV (Therapeutic).

Atasoy Flap Fingertip Reconstruction: Long-term Patient-reported Outcomes in Male Laborers.

Adult, male patients working in manual labor occupations who underwent AF reconstruction for fingertip injuries were identified from an institutional database. Patients were administered an injury-specific questionnaire relating to nail growth, function, aesthetics, cryalgia, and hypersensitivity. They were then administered the QuickDASH questionnaire to report standardized functional impairment and asked about their overall satisfaction with their reconstructed finger. Twelve patients underwent AF fingertip reconstruction between 2015 and 2020. Eleven of these patients agreed to be interviewed, the majority having been treated in the emergency department setting. The overall satisfaction rate was 91% (n = 10). Common sequelae included hook nail 64% (n = 7), cold sensitivity 45% (n = 5), and hypersensitivity 27% (n = 3). There were no flap failures or tissue necrosis. One patient reported a second surgery for improvement of a hook nail deformity. Long-term outcomes of AF reconstruction for fingertip injuries demonstrate high overall satisfaction. Patients appreciated tissue salvage to preserve digit length, even in those unconcerned with aesthetics. Issues reported by patients, such as cold intolerance, hook nail, and decreased tactile sensation, are similar to other treatment options for fingertip injuries.

Fingertip Amputation Reconstruction with VY Advancement Flap: Literature Review and Comparative Analysis of Atasoy and Kutler Flaps.

Many different flaps had been described to cover exposed bone in fingertip amputations and injuries. The variants of VY advancement flap, by far the simplest, had proven to render good functional and aesthetic outcome. We aimed to revisit and compare the various VY advancement flaps in fingertip reconstruction. PubMed [MEDLINE] database was searched for VY advancement flap in fingertip reconstruction. Demographic and outcome data were extracted from relevant studies and comparative analysis was made. Patients with fingertip amputations undergoing reconstruction by either Kutler of Atasoy flaps in our institute, were assessed for sensory recovery, cold intolerance, joint's range of motion, and aesthetic outcomes and results were analysed. Among the 744 articles, 32 citations went full text review and were included, while data of 13 articles were tabulated. Weighted mean of 2PD in Kutler and Atasoy estimated to be 6 and 7.5 mm respectively. Hook nail deformity was in 29% and 35%, pain was present in 71% and 30% patients, in Kutler and Atasoy flaps respectively. Forty fingertips with Allen type II/III were reconstructed. Sensory outcomes of Atasoy flap and Kutler flaps were better than the previous study results. Four patients had cold intolerance. All patients achieved satisfactory aesthetic outcome. Over time, VY advancement flap have been successfully used for reconstruction of Allen type II-IV fingertip amputations, as suggested by the good sensory, functional and aesthetic outcomes.

Epidemiology and Outcome of Nailbed Injuries Managed in Children's Emergency Department: A 10-Year Single-Center Experience.

Fingertip injuries are among the most common hand injuries in children and result in significant health, time, and a financial burden. Nailbed injuries constitute a large proportion of fingertip injuries and are frequent in children. This study aimed to examine the epidemiology, injury patterns, and treatment strategies implemented in patients with nailbed injuries between 0 and 18 years of age. We also wanted to identify various acute and chronic complications associated with nailbed injuries in these patients. This was a single-center retrospective study carried out on the data collected between October 1, 2009, and October 31, 2019. We identified 457 patients with upper extremity nailbed injuries during the study period. Most children were male, accounting for 62.8% (287) of the patients. Door crush injuries (59.5%) resulted in the majority of the nailbed injuries. The commonest place of injury occurrence was home (46.4%), followed by playground (28.4%). The next most frequent areas were public areas (17.5%) and school (7.7%). Simple nailbed laceration with partial avulsion of the nail (44.4%) was the most common type of nailbed injury. Most nailbed injury repairs were done by the pediatric emergency doctor (72.2%). The predictors for the occurrence of complications after nailbed injury were the type of injury (stellate laceration and severe crushed nailbed injuries) and fracture of the distal phalanx. The predictors for the use of antibiotics after nailbed injury in our patients were the mechanism of injury (crushed in door, sports injury, and road traffic accident) and fracture of the distal phalanx. Age was found to be associated with subungual hematomas and avulsion, whereas female sex was found to be associated with crush injuries. In this study, most patients (72.2%) had their nailbed injuries repaired by pediatric emergency doctors. The commonest mechanism of nailbed injury was door crush injuries. Increased awareness and education of the caregivers might help avoid these injuries because the injury mechanism in most of the patients is preventable. Partial nail avulsion with underlying simple laceration of the nailbed was the most frequent type of nailbed injury seen. The complications that were seen after nailbed injuries were fingertip sensitivity (5.3%), split nail deformity (5.3%), infection (3.9%), nonadherence of the nail plate (2%), and hook nail deformity (1%). The predictors for the occurrence of complications after nailbed injury were the type of injury (stellate laceration and severe crushed nailbed injuries) and fracture of the distal phalanx. The predictors for the use of antibiotics after nailbed injury in our patients were the mechanism of injury (crushed in door, sports injury, and road traffic accident) and fracture of the distal phalanx. Age was found to be associated with subungual hematomas and avulsion, whereas female sex was found to be associated with crush injuries. Possessing a robust understanding of the mechanism of injury and the underlying anatomy with a detailed assessment of the nailbed injury is of paramount importance in the management of these patients. An initial thorough assessment and meticulous repair of the nailbed injuries will result in good outcomes with overall few complications.

Modified Oblique Triangular Neurovascular Island Flap Technique to Prevent the Development of Hooked Nail Deformity.

Hooked fingernail deformity can develop after any type of fingertip amputation. A more proximal amputation is associated with a higher probability of developing hooked fingernails. Proximal fingertip amputations with very short remaining nail beds are recommended for revision amputation with nail bed ablation. This procedure eliminates the possibility that the patient may have a functional nail. When the nail matrix is still retained, an oblique triangular neurovascular island flap may preserve the nail and digit length. At our institution, the modified oblique triangular neurovascular island flap is routinely used for patients who underwent fingertip amputation with a retained nail bed. These modifications may aid in preventing the development of hooked nail deformity and creating a round pulp contour without the need for fixation, composite grafts, or distant soft tissue transfer.

A New Triangular Rotation and Advancement Pulp Flap for Lateral Oblique Fingertip Defect.

Background:The fingertip is one of the most common sites of traumatic injuries faced by hand surgeons. In cases of lateral oblique amputation, only limited alternatives are available for reconstruction. This study introduced a new method involving rotation and use of an advancement pulp flap for covering lateral oblique defect and evaluated its outcome.Method:A series of 12 patients with 14 lateral oblique fingertip defects were recruited in this study. All fingertips were unreplantable and were injured distal to the proximal one-third of nail bed, with phalanx exposed. All cases received surgical reconstruction using a triangular rotation and advancement pulp flap. Static 2-point discrimination, cold intolerance, pain, hypersensitivity, range of motion, and aesthetic satisfaction were evaluated 6 months to 12 months postoperation.Result:Bone defect was noted in 7 cases. The area of defect was 10×7–20×12 mm2, and the angle of defect was 30–60 degrees. Mean follow-up was 14.3 months. No hook nail deformity, cold intolerance, and hypersensitivity were observed. One patient complained about pain postoperation, demanding a second operation. Static 2-point discrimination was between 5 and 8 mm in all cases. Range of motion of distal interphalangeal joint recovered to 20–45 degrees at the last follow-up. No stiffness was observed in the interphalangeal or metacarpophalangeal joints. All patients were satisfied with the appearance of the flap.Conclusion:The triangular rotation and advancement pulp flap is simple, safe, and reliable for treating lateral oblique defect of fingertip, providing scope for anatomical reconstruction and fair sensation and aesthetic recovery.

Functional and Aesthetic Evaluation of Expanded Applications of Conservative Management of Fingertip Amputations

Background: Fingertip amputations are the most commontype of amputation injury in the upper extremity. Treatmentsavailable cover a broad range of techniques, surgical andconservative. Although there is no consensus on how theseinjuries should be treated, the goals of treatment should includeminimization of pain, optimization of healing time, preservationof sensibility and length, prevention of painful neuromas,avoidance or limiting of nail deformity, minimization of timelost from work, and provision of an acceptable cosmeticappearance.Patients and Methods: We have prospectively studied 20patients with fingertip amputations of all ages. Daily simplenon adherent non occlusive dressing, paraffin-impregnatedgause, with an ointment initially for debridement then forhealing was used. We used pinch gauge, finger goniometer,caliper and compass to measure pinch tip strength, distalphalanx range of motion and 2 point discrimination distance,respectively.Results: The mean age was (33±17.3) years old. The meanhealing time was (36.4±5.8) days and mean time off workwas (11.6±7.6) days. As regards sensibility 30% complainnumbness, 35% had hyper-sensibility, and 35% show normalsensibility. As regards two point discrimination in the correspondinghealthy fingertip, the mean distance was (4.7±1.5)mm, versus (8.6±2.5) mm in amputated fingertip. There wasno tenderness, cold intolerance, joint stiffness, neuroma ordisability. 50% expressed good aesthetic results, 40% ofpatients were accepted, and 10% had poor aesthetic results.Conclusion: The functional outcome was good, as therewere no tenderness, cold intolerance, joint stiffness, neuromaor disability. Although, longer healing time, time off workwas generally acceptable. Irrespective of that a 35% of patientshave hyper-sensibility and 30% complained of numbness,there were no significant bad impact on the function and earlyreturn to work. Aesthetically, hook nail deformity was theonly cause of poor aesthetic results. However, conservativemanagement of fingertip amputations using simple dailydressing changes, provides good and acceptable results outweighsthe poor results.

Long-term outcome of fingertip reconstruction with the homodigital neurovascular island flap.

Fingertip injuries are frequent and several surgical strategies exist to reconstruct the amputated part and restore function and appearance. Yet, long-term results are rarely published. The purpose of this study was to examine the long-term clinical outcome of neurovascular island flaps for traumatic fingertip amputation of Allen type III/IV injuries. We retrospectively analysed a cohort of patients with traumatic fingertip amputation that underwent reconstruction with a neurovascular island flap from January 2003 to December 2014. No mandatory splinting was applied after surgery. 28 participants (29 fingers) were available for follow-up at mean 8years after reconstruction. Activities of daily living were measured with the disabilities of the arm, shoulder and hand questionnaire. Grip strength and finger motion were assessed using a Jamar dynamometer and a goniometer. Two-point discrimination and Semmes-Weinstein monofilaments were used to evaluate sensory recovery. No intraoperative complications occurred and all flaps survived. Mean flap size was 4.7 ± 0.6cm2. Active motion of the fingers was over 95% of the contralateral side at follow-up. Three patients showed mild extension lag of the proximal interphalangeal joint. The grip strength of the affected hand and of each of the affected fingers was over 70% of the contralateral side. In comparison to the contralateral side we did not detect any significant difference for the Semmes-Weinstein monofilament test, but two-point discrimination (5.1 ± 1.7mm) was significantly impaired. According to the Lim classification 1 of 14 nails with hook nail deformity showed grade 3 breaking of the nail. The DASH score was 16.0. All patients returned to their original occupation and patient satisfaction with the procedure was high. The risk for disabling flexion contracture seems to be small even without mandatory splinting. Neurovascular island flaps for fingertip amputation of Allen type III/IV injuries are a reliable tool in fingertip reconstruction in the long term.

Long-Term Outcomes of Atasoy Flap in Children With Distal Finger Trauma

Distal finger trauma is one of the most frequent emergencies in children and has the potential for functional and cosmetic damage to the hand. The Atasoy flap (AF) is a vascularized, subcutaneous pedicle V-Y advancement flap used to cover a loss of distal finger substance. Our hypothesis was that the AF is a safe, reliable flap that results in few complications and gives satisfactory functional and cosmetic results in children. We retrospectively assessed children with distal finger trauma and AF pulp reconstruction in our pediatric orthopedic department between 2008 and 2017. The lesion zone was classified, and we also evaluated necrosis, infection, the shape of the pulp, pulp sensitivity (Weber test), hyponychial scarring, and the presence of a hook nail deformity. Lastly, we compared patients who developed a hook nail with those who did not. Thirty children were included (mean age at trauma, 6.4 years [range, 1.3-15.7 years]). In 21 cases, the finger damage was located in Ishikawa subzone II. No cases of necrosis or infection were reported. Epicritical tactile sensitivity was good in 20 patients (67%). A hook nail deformity was observed in 15 children (50%) and hyponychial scarring in 22 patients (73%). The pulp had a normal shape in 13 children (43%). The hook nail group displayed more hyponychial scarring, greater nail dystrophy, and lower pulp sensitivity. The AF yielded contrasting results. High reliability, good coverage, and minimal donor-site morbidity were compromised by suboptimal tip length/shape, nail appearance, and sensitivity. Therapeutic IV.

Reading man flap for repair of soft tissue defects in distal fingers

Objective To explore the Reading man flap for the treatment of soft tissue defects in distal fingers. Methods From May, 2014 to June, 2017, Reading man flaps were transferred in the emergency room to repair soft tissue defects in distal fingers in 46 patients. There were 28 cases of finger pulp defects, 6 cases of dorsal defects and 12 cases of finger stump defects with the size of soft tissue defects ranged from 1.0 cm×0.9 cm to 2.2 cm×2.0 cm (average, 1.2 cm×1.3 cm). The volar, dorsal and hybrid flaps were 28, 6 and 12 cases respectively. The average size of the major flap and minor flap were 1.8 cm×1.2 cm and 1.4 cm×0.8 cm, respectively. All donor sites were sutured directly. All patients were followed-up by review in the outpatient department. Results The consumed operative time was 35-48 min, with an average of 37.8 min. Prophylactic antibiotics and wound dressing were conducted postoperatively. The tip of the minor flaps occurred inflammation and small blister in 2 cases and eased by removal of the tip sutures. Traumatic neuralgia occurred in 1 case and self-healed after 3 months. Twenty-six cases were followed-up at least 11 months, which were 16 cases of finger pulp defects, 3 of dorsal defects and 7 of finger stump defects. On an average of 10.5 (9-27) months followed-up, all flaps survived. Except 4 cases with slim hook nail deformity, the remaining flaps were observed with satisfactory texture and appearance, the bulky deformity and scar contracture did not occur. Two points distinguishment on the major and minor flaps were 3.3-6.2 (average, 4.5) mm and 5.5-9.8 (average, 7.1) mm respectively. According to the Trial Standard for Evaluation of Upper Limb Function of Chinese Society of Hand Surgery, it was excellent in 28 cases, good in 11 cases and moderate in 7 cases, with the overall excellent and good rate of 84.8%. Conclusion The Reading man flap is a good option for treatment of the small size soft tissu defect in distal fingers with the advantages of simple procedure, high success rate, good appearance and sensory recovery. Key words: Reading man flap; Surgical flap; Soft tissue defect; Finger; Repair

A New Technique for Correction of Hook Nail Deformity: Modified Antenna Procedure

A New Technique for Correction of Hook Nail Deformity: Modified Antenna Procedure