Nail Bed Research Articles

Reconstruction of Central-Type Nail Bed Defect Using a Subcutaneous Flap and Subsequent Nailbed Graft

Full-thickness nail bed defects with exposure of the distal phalanx are difficult to reconstruct with limited options for bone coverage. A subcutaneous flap can effectively cover bone exposure, followed by a nail bed graft. We report a case of successful nail bed reconstruction using this approach, incorporating a split-thickness nail bed graft. A 59-year-old woman sustained injuries to the nail bed of the right middle finger from a blender blade. The defect, measuring 1.2 × 0.6 cm, was located in the center of the nail bed with associated bone exposure. Both lateral nail folds remained intact and our aim was to reconstruct the defect without disrupting these structures. A subcutaneous flap incorporating the digital artery was elevated. The flap was then transposed beneath the lateral nail fold and uninjured nail bed to provide coverage for the defect. This technique allowed for the reconstruction of the damaged area while preserving the vascular supply and ensuring adequate soft-tissue coverage. Three weeks post-surgery, the flap survived, and the eponychial folds were all preserved, allowing for a subsequent split-thickness nail bed graft. At 12 months post-surgery, the outcome was evaluated as “very good” according to Zook’s criteria.

Omparative Study Between Pulsed and Continuous Itraconazole for the Treatment of Onychomycosis

Objective: To compare efficacy of pulsed versus continuous daily oral Itraconazole in the treatment of onychomycosis. Study Design: Randomized Control Trial (ClinicalTrials.gov: NCT05567484). Place and Duration of Study: Department of Dermatology, Combined Military Hospital, Abbottabad, Pakistan, from May to Dec 2021. Methodology: We enrolled 60 patients whose toenails showed signs of onychomycosis (crumbling nail plates, thicker nail beds, and yellowing). They were randomly divided into Group-A and Group-B, with 30 patients each. Group -A (Pulse Therapy) took two capsules of oral Itraconazole 100 mg twice weekly for one week every month for three months while Group-B (Continuous Therapy) received continuous oral 100 mg of Itraconazole once daily for 12 weeks continuously. Patients were subjected to an Onychomycosis Severity Index-based clinical evaluation. Results: In Group-A (Pulse Therapy), 25(83.3%) patients showed mycological cure whereas in Group-B (Continuous Therapy), 23(76.7%) patients showed mycological cure but difference in the efficacy of both drugs was not statistically significant (p-value=0.519). Conclusion: Pulsed therapy with Itraconazole and continuous Itraconazole therapy have comparable efficacies in treating dermatophyte toenail onychomycosis.

Onychoscopy in Palmoplantar Psoriasis: A Comparative Study of Nonpustular Palmoplantar Psoriasis and Palmoplantar Pustulosis

Introduction: Palmoplantar psoriasis (PP) is classified as nonpustular psoriasis (NPPP) or palmoplantar pustulosis (PPP). Objective: We sought to shed light on the phenotypic diversity of nail psoriasis (NP) and conducted a thorough study of the dermoscopic features of nail lesions from patients with NPPP and PPP. Methods: A prospective study included 35 patients with NPPP and 20 patients with PPP who had macroscopic NP changes in at least three of their nails. Demographic and clinical data, such as general characteristics, history, a thorough dermatological examination, and musculoskeletal assessment, were recorded. Each patient had their nails evaluated with video dermoscopy. The statistical analysis was carried out using SPSS software, including descriptive and analytical statistics. Results: Dermoscopic patterns of nail lesions in both groups differed from those seen in psoriasis vulgaris (PV). Trachyonychia was the most common dermoscopic pattern among NPPP patients. Nail bed pustules were found in 75% of the PPP patients, and they were the most common dermoscopic finding identifying PPP nail lesions. In comparison to the NPPP group, patients with PPP had a higher frequency of psoriatic arthritis (PsA) and higher PP and NP severity scores. In the PPP group, all patients with PsA had pustules. Conclusions: NP has a heterogeneous presentation and various clinical manifestations in NPPP, PPP, and PV. The differences in dermoscopic patterns of nail lesions among NPPP, PPP, and PV reflect the diseases' distinct characteristics. A thorough dermoscopic examination of the nails may reveal information about both the underlying pathophysiological pathways and the overall course of psoriasis.

Worn-Down Nails: A Rare Entity

This case report discusses a rare condition known as bidet nail syndrome, characterised by worn-down triangular nails resulting from repetitive rubbing against bidet porcelain during genital area cleaning. The patient, a 35-year-old male pharmacist, presented with splitting and redness in the nail plates of both big toes, attributed to tight and anteriorly covered shoes. Clinical examination revealed a triangular area of nail thinning with slight redness and a thin brown line along the edges. Dermoscopic findings indicated nail bed reddening, enlarged capillaries and small areas of bleeding corresponding to nail thinning. The provisional diagnosis included worn-down nails, lacquer nails and onychoteiromania, with the final confirmation of worn-down nails. The patient showed significant improvement after changing footwear, emphasising the importance of lifestyle modifications. The bidet nail syndrome, initially described in 1999, is associated with chronic scratching or manual labour, with susceptibility to nail plate damage varying among individuals. This case underscores the need for dermatologists to recognise and differentiate worn-down nails from similar conditions, enabling accurate diagnosis and avoiding unnecessary treatments. Overall, bidet nail syndrome is a self-limiting condition, emphasising the importance of a thorough medical history for effective management.

Onychomadesis and Beau’s Lines- Rare Complications of Handfoot- and-mouth Disease

Hand-foot-and-mouth disease (HFMD) is a common self-limiting viral infection in children caused by Coxsackievirus A16 and human enterovirus 71, presenting with fever, erythematous papulovesicular eruptions/ blisters on the palms, soles, knees, buttocks, and oral mucosa. Although rare, complications may arise in nails e. g. onychomadesis (nail separation) and Beau’s lines (transverse lines on the nails). These typically appear within four to eight weeks of HFMD and persist for around 5-6 weeks. No active treatment is required and these nail changes resolve spontaneously within few weeks as the nail bed remain intact. We present here a boy of 4 years who presented with such nail changes after around 5 weeks of HFM disease and diagnosed as onychomadesis and Beau’s lines after ruling out other possible causes of nail changes. BANGLADESH J CHILD HEALTH 2023; VOL 47 (1) : 47-50

Effectiveness of Antifungal Treatment for Onychomycosis

Onychomycosis is a prevalent fungal infection of the nails, which causes thickening, discoloration, and detachment of the nail bed. The condition is mainly caused by various fungal species, including dermatophytes, yeasts and molds. Treatment of onychomycosis is complex, with antifungal drugs playing a key role. This research aimed to evaluate the effectiveness of various antifungal treatments, both topical and systemic, in managing onychomycosis. This research used a descriptive qualitative approach, using secondary data through documentation analysis. Data were triangulated to increase reliability and validity. The findings showed that the effectiveness of antifungal treatment varied depending on the type of drug, duration of treatment, and patient compliance. Systemic antifungals, such as terbinafine and itraconazole, showed higher cure rates compared to topical treatments such as ciclopirox and amorolfine. However, all treatments had high relapse rates, underscoring the need for continuous monitoring and customized therapy. The implications of this research demonstrate the importance of personalized treatment plans and the development of strategies to prevent relapse, which remains a significant challenge in the management of onychomycosis.

Automatic evaluation of Nail Psoriasis Severity Index using deep learning algorithm.

Nail psoriasis is a chronic condition characterized by nail dystrophy affecting the nail matrix and bed. The severity of nail psoriasis is commonly assessed using the Nail Psoriasis Severity Index (NAPSI), which evaluates the characteristics and extent of nail involvement. Although the NAPSI is numeric, reproducible, and simple, the assessment process is time-consuming and often challenging to use in real-world clinical settings. To overcome the time-consuming nature of NAPSI assessment, we aimed to develop a deep learning algorithm that can rapidly and reliably evaluate NAPSI, thereby providing numerous clinical and research advantages. We developed a dataset consisting of 7054 single fingernail images cropped from images of the dorsum of the hands of 634 patients with psoriasis. We annotated the eight features of the NAPSI in a single nail using bounding boxes and trained the YOLOv7-based deep learning algorithm using this annotation. The performance of the deep learning algorithm (DLA) was evaluated by comparing the NAPSI estimated using the DLA with the ground truth of the test dataset. The NAPSI evaluated using the DLA differed by 2 points from the ground truth in 98.6% of the images. The accuracy and mean absolute error of the model were 67.6% and 0.449, respectively. The intraclass correlation coefficient was 0.876, indicating good agreement. Our results showed that the DLA can rapidly and accurately evaluate the NAPSI. The rapid and accurate NAPSI assessment by the DLA is not only applicable in clinical settings, but also provides research advantages by enabling rapid NAPSI evaluations of previously collected nail images.

Ultrasound nail assessment in patients with psoriasic arthritis: is there an association of findings with clinical scores?

BackgroundPsoriatic arthritis can involve several domains. Due to its multifaceted nature and its frequent comorbidities such as depression, obesity, osteoarthritis and fibromyalgia, it is difficult to monitor these patients because the clinical scores involve subjective data. High-resolution ultrasound probes allowed the evaluation of more superficial structures, such as the nails and their synovio-entheseal framework, in close relationship with the enthesis of the distal extensor digitorum tendon. Nail ultrasound studies vary in terms of the parameters and fingers studied and in their findings.ObjectivesTo describe the most significant sonographic nail changes and the most affected fingers in psoriatic arthritis and to verify the association of nail ultrasound findings with clinical scores (nail psoriasis severity index (NAPSI), ankylosing spondylitis disease activity score with C-reactive protein (ASDAS-CRP), minimal disease activity (MDA), disease activity index for psoriatic arthritis (DAPSA)).MethodsThis was a cross-sectional study with 52 patients with psoriatic arthritis at the Hospital de Clínicas do Paraná and 50 controls. A total of 1016 nails were analyzed (517 from patients with psoriatic arthritis and 499 from controls). Ultrasonography of the nails of the 10 fingers was performed to assess the trilaminar appearance, measure the distance from the nail bed, identify synovitis of the distal interphalangeal joints and the presence of a power Doppler signal from the nail matrix/nail bed. The captured images were independently evaluated by a rheumatologist with expertise in musculoskeletal ultrasound. Data analysis was performed using IBM SPSS Statistics v.28.0.0 software, and the association of nail plate changes, nail bed distance and power Doppler signal with the NAPSI, DAPSA, MDA and ASDAS-PCR were calculated. Spearman correlation coefficients were estimated to analyze the correlations between pairs of quantitative variables. Student’s t test and the Mann‒Whitney U test were used to compare quantitative variables, and Fisher’s exact test was used to compare categorical variables between patients and controls. The nonparametric Mann‒Whitney U and Kruskal‒Wallis tests were used to compare groups according to the MDA or DAPSA classification.ResultsThe Doppler signal of the nail matrix and nail bed was more frequently identified in patients (44.2%) than in controls (6%), and the difference in the mean power Doppler signal between the two groups was significant (p < 0.001). Changes in the nail plate were more common in the right thumb (44.2%), left thumb (36.5%) and second finger on the right hand (32.7%). The number of fingers with nail plate changes, enthesitis, paratendinitis, grayscale synovitis and DIP involvement in the distal interphalangeal joints was higher among patients with psoriatic arthritis (p < 0.001). There were found some correlations between US findings and clinical scores: ultrasound nail involvement and the NAPSI score (p = 0.034), the number of fingers and mean change in the nail plate and the ASDAS-CRP (p = 0.030). DAPSA (remission/low activity versus moderate/high activity) was associated to the mean change in the nail plate (p < 0.013). CONCLUSIONS: Nail ultrasound has the potential to assist in the capturing of the actual disease activity status in patients with psoriatic arthritis.

Tangential biopsy of the nail bed and matrix, with plate evaluation, for diagnosis of lichen planus

Tangential biopsy of the nail bed and matrix, with plate evaluation, for diagnosis of lichen planus

Finger Pulp Injuries Treated With Needle And Figure Of 8 Suturing

Background: injuries to the finger pulp are encountered in occupational, household work and rta.in the present study, fingertip injuries were treated by reducing the fracture fragments, repositioning the nail plate in the nail fold, and securing it with the needle vertical figure of eight tension band sutures. Objective: to know the clinical outcomes of finger pulp injuries treated with 23g needle fixation and figure of 8 suturing. Methodology: 15 patients were included in the study. The study was done at chennai, tamil nadu, a.c.s. Medical college and hospital on patients with finger pulp injuries in casualty as an outpatient. This interventional study was done for 12 months. All patients were followed up for 6 months. Results: most of the patients were aged above 18. Most of the patients were males. The thumb finger was most commonly involved. The right side is more commonly affected. All patients were given antibiotics orally for 2 weeks. Fracture healing happened in 6 weeks for most of the patients. Union was achieved in 8 to 9 weeks for most of the patients. Conclusion: using an 23g needle instead of k-wire fixation for treating associated fractures of the distal phalanx has enhanced versatility and yielded good outcomes. This approach also circumvents the formal repair of the nail bed, promoting smooth healing of the injury

Fingertip Reconstruction in Hand Injuries

Fingertip amputations are a significant issue in the United States, with approximately 45,000 performed annually, with a 7.5 per 100,000 incidence rate. The primary cause of finger injuries is metal objects and bladed hand instruments, which can lead to cuts, loss of limbs, or damage to nerves and blood vessels. Therapy aims to restore sensation, long-lastingness, and bone support for nail development. Inadequate management can result in cosmetic issues, cold sensitivity, skin soreness, and persistent impairment in functionality. Nail bed injuries, such as lacerations, avulsions, and crush injuries, can result in post-traumatic fingertip amputation. Physical examinations are necessary to evaluate the functional and sensory capabilities of the damaged finger. Surgical intervention is necessary for severe cases, with primary closure or revision amputation being the preferred procedure. Full-thickness skin grafting is also used for fingertip amputations, preserving the structure of the recipient's fingers and addressing areas with insufficient skin. Flap repair is a method for managing fingertip amputations, using skin from another area or distant region. Local flaps are best for small covering areas, while regional flaps are used for extensive incisions. These flaps prevent prolonged immobilization and allow for a return of feeling in the fingertip. Post-amputation complications include delayed wound healing, nail abnormalities, heightened sensitivity, pain, intolerance to cold, scar retraction, limited finger movement, persistent ulcers, infection, and loss of tissue flaps. Inadequate management of fingertip amputations can lead to cosmetic flaws, reduced tolerance to cold, and increased skin sensitivity.

YOLOv8-Based System for Nail Capillary Detection on a Single-Board Computer.

Nail capillaroscopic examination is an inexpensive and easily applicable method to identify capillary morphological changes in patients with conditions such as systemic sclerosis and Raynaud's. The detection of changes in capillaries makes an important contribution to diagnosing these diseases. Capillary morphology is important in the symptoms of these diseases, and capillary diameter, visibility, distribution, length, microbleeds, blood flow, and density are important indicators in capillaroscopic evaluation. Manual examination to determine these parameters is subjective, causes inconsistent results, and is labor-intensive and time-consuming. To overcome these problems, a YOLOv8s-based system was proposed in this paper to detect the number, thickness, and density of capillaries in the nail bed. The system's components include database systems that store the analysis results, artificial intelligence-based software that runs on the SBC (Single-Board Computer), and recorded microscope images. mAP and F1_score parameters were used to evaluate the system's performance, and values of 0.882 and 0.83 were obtained. The proposed system is promising in improving the diagnosis process of diseases such as systemic sclerosis and Raynaud's by providing objective measurements and the early diagnosis and monitoring of diseases.

Zosteriform Cutaneous Metastasis from Breast Cancer: A Case Report

Introduction: Cutaneous metastases are observed in approximately 10% of oncology patients, often indicating either a persistent solid tumor or the recurrence of neoplastic disease. The most prevalent cause of cutaneous metastases in females is breast cancer. Patients with breast cancer may exhibit cutaneous manifestations at the initial diagnosis; however, these metastases more frequently emerge well after the initial diagnosis and treatment. The cutaneous lesions resulting from metastatic breast carcinoma display considerable variability in appearance. Typically, they manifest as firm, flesh-colored to red, smooth or ulcerated, or crusted nodules, papules, and plaques on the ipsilateral chest wall and breast. Additionally, unusual sites for breast cancer cutaneous metastases include the eyelids, inframammary folds, ipsilateral lymphedematous arm, scalp, subungual nail bed, and umbilicus. Skin metastases can also occur in mastectomy scars and radiation therapy ports. Several distinct patterns of skin metastases are recognized in breast cancer patients: carcinoma erysipelatoides, carcinoma telangiectoides, and carcinoma encuirasse. Recently, carcinoma hemorrhagiectoides has also been documented. The pleomorphic nature of breast cancer metastases can mimic various benign and malignant conditions, such as collision tumors, cysts, dermatofibromas, milia-en-plaque, melanoma, non-melanoma skin cancers, cellulitis, folliculitis, herpes zoster, paronychia, erythema annulare centrifugum, urticaria, alopecia areata, dermatitis, hidradenitis suppurativa, scleroderma, angiokeratoma, angiosarcoma, lymphangioma circumscriptum, purpura, and pyogenic granuloma. Consequently, it is crucial to consider the possibility of cutaneous metastasis from breast cancer in any patient, whether previously diagnosed with breast cancer or not, who presents with new or treatment-resistant cutaneous lesions. Confirmation of the diagnosis necessitates a biopsy of the skin lesion. ...........

Nail Bed Regeneration by Excision of Distal Scarred Matrix in a Patient with Porphyria Cutanea Tarda.

Onycholysis secondary to nail bed scarring can be a challenging problem for hand surgeons, given the relatively few techniques available for nail bed lengthening. Here, we present the case of a patient with upper extremity onycholysis, secondary to porphyria cutanea tarda. We used a technique first described by Lemperle et al in 2003 to successfully lengthen the nail bed and improve the appearance of the nail plate. This involved full-thickness excision of a crescent-shaped wedge of the distal nail bed in all five right sided digits in a single operation. We found this technique to be simple and effective, meeting our patient's goals after just one excision.

Subungual exostosis and chronic onychocryptosis: An intricate relationship - clinical review and management

Subungual exostosis (SE) is a relatively common benign bone tumor occurring primarily in the distal phalanx of the toes, particularly the hallux. Nail deformities, such as onychocryptosis / paronychia, can present concurrently, leading to complex clinical scenarios. Although SE and onychocryptosis are separate conditions, their clinical presentations can sometimes overlap, mainly when SE occurs under the nail bed, leading to nail deformation and subsequent ingrowth. When an ingrown toenail accompanies SE, the situation can become more complex due to increased pain and risk of infection. Diagnosis in these cases requires careful clinical examination and imaging studies. Any surgical intervention for the SE should consider concurrent pathological nail growth and nail bed abnormalities. The ultimate treatment goal is restoring normal anatomy, including salvage of the nail plate.Given these conditions' potential overlap and shared symptomatology, clinical vigilance is essential for appropriate diagnosis and treatment.This paper reviews the interplay between these conditions, their combined impact on patient morbidity, and effective surgical management strategies.

Diagnostic Signs and Symptoms of Cyanocobalamin Deficiency at Rural Setting in India: Novel Method of Supplementation.

Cyanocobalamin or B12 deficiency is common in the Indian population, and responsible for anemia. Various clinical manifestations include central nervous system and cardiovascular manifestations, secondary to a rise in serum homocysteine levels. In a routine outpatient department at Bawaskar Hospital and Clinical Research Centre, Mahad, patients with suspected clinical signs and symptoms suggestive of cyanocobalamin deficiency were studied in detail regarding their dietary habits, serum hemoglobin, B12, and homocysteine levels. A total of 1,992 (female 1,009, 50.75%) were clinically examined in detail. Of these, 945 (49.94%), 999 (50.17%), and 48 (2.40%) were strict vegetarians, both vegetarian and nonvegetarian, and strict nonvegetarians, respectively. Common occupations associated with B12 deficiency include 666 (33.4%) housewives, 396 (19.9%) service workers, 316 (15.9%) businesspeople, 180 (9%), and 198 (9.9%) retired and industrial populations, respectively. Clinical manifestations include recurrent scalp hair loss in 268 (13.5%), poor memory in 240 (12%), tingling and numbness in 200 (10%), and generalized weakness in 387 (19.4%) patients. Additionally, 541 (27.15%) patients had pigmentation of the nail bed, knuckles, oral mucosa, and tongue, while 237 (10.81%) suffered from hypertension and ischemic heart disease. During the process of preparation of vegetarian and nonvegetarian food, there is a 30-48% reduction in vitamin content. Supplementation of vitamin by adding table salt to food on a plate at the time of eating improves the vitamin level in the blood. In the absence of laboratory investigations in rural settings, clinical signs and symptoms are helpful in detecting B12 deficiency. Directly adding vitamin powder, similar to table salt, to cooked food on the plate improved blood vitamin levels.

The Normal Growth Rate of Human Fingernails in Indian Population.

Background: India, with a large population working in industries, has a considerable amount of nail bed injuries day to day as well as infections and other issues with nails. However, there are no normative data for nail growth in our population. This study aims to measure and analyze the rate of nail growth in the Indian population, which will be a valuable tool for clinical assessment and treatment. Objective: The aim of the study was to estimate the average rate of nail growth of all fingers in the Indian population between the age group of 18 to 40 years. Materials and Methods: Fifty young adults whose 500 fingernails were painted with three coats of nail polish following a standardized protocol, and the rate of the growth of the nails was recorded with a digital Vernier caliper from the nail fold every 10 days for 1 month. Results: The average fingernail growth is 0.103 mm/d. There is no correlation of nail growth with sex or hand dominance. Nail growth is more in the left index finger (0.13 mm/d) and the left thumb, while it is the least in little fingers (0.101 mm/d). Initial fingernail growth was higher in older individuals, however. At the end of the study period, nail growth was equal. The nail growth rate reduces as the days progress. Conclusion: We have reported the normative data of nail growth as 0.103 mm per day. In the majority of the healthy population, this rate would hold true.

The concept of onychodermis containing onychofibroblasts has histological (microanatomical), immunohistochemical as well as molecular basis.

The terms "onychofibroblast" (nail-specific fibroblast) and onychodermis (nail-specific dermis) were first introduced in 2006 and 2012, respectively, based on distinctive histologic and immunohistochemical features from the dermis of the surrounding skin and have been demonstrated in multiple studies. Recently, based on molecular research, the definition of onychodermis containing onychofibroblasts has been expanded to encompass the area located between the nail matrix and bed epithelium and periosteum. Single-cell RNA sequencing and in situ hybridization demonstrated that onychofibroblasts within the onychodermis express the genes including RSPO4, MSX1, WIF-1, and BMP5, which are implicated in nail formation and/or in disorders with nail phenotype. A mutation in RSPO4, a component of the Wnt signaling pathway, causes anonychia congenita. Nail matrix onychodermis and nail bed onychodermis share many similar characteristics which differ from the surrounding normal dermis of the skin. Comparative spatial transcriptomic and single-cell analyses of human nail units and hair follicles suggest that onychodermis is the counterpart of follicular dermal papilla, which plays a key role in hair follicle growth and morphogenesis. Onychomatricoma, as a nail-specific tumor, has been demonstrated to be a mesenchymal tumor that originates from onychofibroblasts and is associated with the upregulation of Wnt signaling. Collectively, the onychodermis and onychofibroblasts play crucial roles in nail development and these specialized nail mesenchymal elements are key components in the pathogenesis of onychomatricoma. The concept of onychodermis containing onychofibroblasts is very important for nail biology and pathology.

Nail Disorders in Patients Living with HIV Coinfected with Monkeypox: A Clinical Study in 69 Mexican Cases

Introduction: Several infectious diseases can present nail manifestations, which may be useful for diagnosis and prognosis, and only a few reports have been made regarding monkeypox (mpox). The objective of this study was to describe the clinical characteristics of nail alterations in patients living with HIV coinfected with mpox. Methods: A prospective, cross-sectional study included patients living with HIV/AIDS, coinfected with mpox. We examined all 20 nails in search of nail plate alterations. Patients were divided into two groups, with and without nail disease, and the CD4 count was noted according to the Centers for Disease Control and Prevention (CDC) classification. A χ2 or Fisher’s exact test for qualitative variables and Mann-Whitney U and Kruskal-Wallis tests with post hoc Bonferroni test for quantitative variables were used to compare them. Data were analyzed with the SPSS Statistics 25 software. Results: Sixty-nine patients were included. The frequency of nail involvement was 58%. Papulonodular lesions were the most frequent type identified, with 21 cases (30.4%). A significant difference was observed between patients with nail disease versus median CD4 count (160 vs. 700/mm3; p = 0.002) and median HIV viral load (45,000 vs. 900/mL; p = 0.009). When comparing the characteristics of the nail lesions with the CDC Classification System for HIV infection by the CD4 count, a significant difference was observed in foot involvement, splinter hemorrhages, papulo-nodular lesions, anonychia, onychomadesis, acute paronychia, and nail bed ulcer-atrophy (p < 0.05). Conclusions: The frequency of nail lesions is high in patients living with HIV coinfected with mpox. In addition, they tend to be more destructive in patients with lower CD4 counts and higher viral loads.

Fingertip amputations in children: Atasoy flap’s indications and limitations

IntroductionThe Atasoy flap is considered simple and reliable for covering distal digital defects in adults. Various studies in children have shown more contrasting results, particularly in terms of aesthetics and function. The aim of this study is to evaluate the long-term results of this flap specifically in children, in order to determine its limitations and indications. HypothesisThe Atasoy flap is reliable and reproducible for coverage of distal digital substance loss up to zone 2 in children. Materials and methodsFifty-six children who benefited from an Atasoy flap operated on between January 2017 and January 2020 were included. Lesion area, operative technique, postoperative complications (infection, healing difficulties, necrosis), and ultimately nail appearance, cold intolerance or finger pain, finger eviction, extension defect, and final parental satisfaction were analyzed. ResultsForty-nine children were evaluated with a mean follow-up of 18 months (min = 3 months, max = 38 months, SD = 11.3 months). Eighteen children had a hook nail, resulting in 6 of them having their finger excluded. The majority of hook nails were found in zone III and in proximal zone II lesions (12 cases). Eighty-nine percent of children with distal suture fixation to the nail bed (8 children) had this complication. Cold intolerance was present in 9 children. There were no cases of extension failure or early post-operative complications. Final parent satisfaction was 9.1/10 (min = 5, max = 10, SD = 1.3). ConclusionThe Atasoy flap in children appears reliable for covering loss of distal digital substance. The main complication is the occurrence of hook nails. Compliance with its indications (transverse substance loss not exceeding the proximal third of zone II) and a precise surgical technique (distal needle fixation without suturing to the nail bed, deep flap lift, non-closure of the donor site) help limit this risk. Level of evidenceIV; retrospective study.