Nail Defects Research Articles

The Expanded Application of the Acellular Dermal Matrix: Traumatic Nail Bed Defect of the Digits.

Reconstruction of traumatic nail bed defects in the digits is a frequently encountered procedure, yet often presents many challenges. In such scenarios, staged procedures may be required with significant limitations in shape and increased donor site morbidity, particularly when multiple defects are present. In this study, we introduce a simple method for the reconstruction of nail bed defects using an acellular dermal matrix (ADM). The study involved 19 digits with nail defects, which underwent reconstruction using an ADM graft. The surgical procedure was performed on all patients on the day of injury, after which they were promptly discharged. The dimensions of the defect ranged from 0.5 × 0.5 cm to a maximum of 2 × 3 cm (average, 0.9 × 1.4 cm). Final examinations were performed at postoperative 5-11 months (average, 6.6 months). All ADM grafts were successfully taken. Nail growth was observed at an average of 4 months after surgery in the treated finger. The surgical results were retrospectively evaluated using the Zook criteria. Outcomes were "excellent" in 11 patients (57.9%), "very good" in five patients (26.3%), "good" in two patients (10.5%), and "fair" in one patient (5.2%). The expanded application of ADM explored in this study illustrates a straightforward method for the reconstruction of traumatic nail bed defects, providing effective results in a single stage without incurring donor site morbidity.

Reconstruction of Composite Soft Tissue Defect in the Distal Finger Using Partial Toenail Flap Transfer.

Composite tissue loss involving the distal finger pulp and the nail is a common but challenging finger injury to restore. This study introduces a reconstruction procedure for a distal finger pulp and nail defect using a partial toenail flap transfer. Twenty digits, including 16 thumbs, two index fingers, and two middle fingers, with composite soft tissue defects were treated with a partial toenail flap transfer from October 2015 to January 2020. Shortening revision of the great toe phalanx, a V-Y advancement flap of the toe pulp, and a local pedicle flap from a second toe transfer were used to cover the donor sites, and no skin grafts were required. Functionality was evaluated using the validated Spanish version of the Quick-DASH scale. The aesthetics of both the reconstructed and donor sites were evaluated using the Vancouver Scar Scale (VSS). The static two-point discrimination (2-PD) of the finger pulp was used as a measure of tactile agnosia. All donor site wounds healed well. The average follow-up time was 23.6 months (6-39 months). The mean Quick-DASH functional score was 7.1. The VSS scores were 4.02 ± 0.29 and 4.00 ± 0.38 for the reconstructed and donor sites, respectively. The static 2-PD of finger pulp was 4.5 ± 0.76 mm. The patients were satisfied with finger motion, sensory function, and aesthetic contour. Partial toenail flap transfer is the recommended treatment to regain motion, sensation, function, and a satisfactory aesthetic appearance when considering repairing a composite soft tissue distal finger defect with accompanying loss of the perionychium, particularly in the thumb, index finger, or middle finger.

SGVM: Semantic-Guided Variational Model for Sealing Nail Defect Extraction Within Albedo Domain via Photometric Stereo

SGVM: Semantic-Guided Variational Model for Sealing Nail Defect Extraction Within Albedo Domain via Photometric Stereo

Clinicopathological Profiles of Anemia in Children of 6 Months to 17 Years Age

Introduction: Anaemia is defined as a decreased concentration of hemoglobin and RBC mass as compared to the values in age-matched controls. Anaemia in children is one of the major social health problems in India and in many parts of the world, since anemic children have reduced exercise capacity, slower rate of growth, impaired cognitive development, and delayed wound healing. The aim of this study was to find the prevalence of anemia in different age group, sex, and its pattern of severity in hospitalized children. Materials and Methods: This are a Retrospective Study conducted in the Department of Pediatrics, Apollo Institute of Medical Sciences and Research among Children with Anemia and those Admitted with other Complaints but Incidentally have Found to have Anemia. During physical examination following signs and symptoms were noted: Pallor, edema, clubbing, skin (dryness, rashes, irritation), abnormal pigmentation, coarse hair, puffiness of face, thinning of eyebrows, nail defects, ulceration, abnormalities in genitalia, hand and feet abnormalities, nose, eyes, cranium, ear and face. Grading of anemia among different age groups was done using WHO Hemoglobin concentrations for the diagnosis of anemia and assessment of severity criteria. Microscopic evaluation of blood was also done to obtain the microscopic picture. Result: In our study, According to WHO criteria for diagnosis and assessment of severity of anemia, a total of 90 children were graded as having mild anemia 40 (44.4%), followed by 35 (38.9%) were graded as having severe anemia and remaining moderate anemia 15 (16.7%). Microcytic hypochromic picture in 56%, Normocytic hypochromic anaemia 18.8%, normocytic normochromic in 12.2%, Dimorphic anaemia 7.7% and macrocytic in 4.4% cases. Conclusion: Paediatric anaemias are very common since children are the most vulnerable population for occurrence of these anaemias. This necessitates prompt screening and early diagnosis through investigations byutilization of available advanced technical modalities in order to initiate timely treatment and appropriate management.

Eponychial Flap: A Simpler Way to Achieve Better Aesthetic Outcome in a Fingertip Amputation.

Background There are numerous flaps described for the treatment of fingertip amputation. Shortened nail length resulting from amputation is an ignored area. Eponychial flap is a simple procedure that helps to lengthen the nail plate and correct this deformity. Methods This case-control study was conducted between April 2016 and June 2020 aimed at comparing the outcome of nail defects in a fingertip amputation treated with eponychial flap and those treated without an eponychial flap. Results Among 165 patients treated for fingertip injury, 78 were treated with eponychial flap (group A) and 87 without eponychial flap (group B). In group A, the nail length was 72.54% (standard deviation [SD]: 14.4) and the nail plate area was 74.35% (SD: 13.96) compared with the contralateral uninjured nail. These results were significantly better ( p = 0.000) compared with group B where the values were 36.49 (SD: 8.45) and 35.8% (SD: 8.4), respectively. The aesthetic outcome score was also significantly higher in group A patients ( p = 0.002). The patient satisfaction was superior in group A compared with group B. Conclusion The eponychial flap is a simple and reliable technique that can be used to restore the visible nail length in traumatic fingertip defects. Compared with fingers treated without nail lengthening with eponychial flap gives excellent aesthetic results.

Mimical reconstruction and aesthetic repair of the nail after resection of subungual melanocytic nevus

BackgroundThis study aimed to report the outcomes of mimical reconstruction and aesthetic repair of the nail.MethodsWhen the pigmented bands were more than 1/2 the width of the whole nail, mimical reconstruction of the nail was performed, with a lateral toe pulp island flap covering the wound via the subcutaneous channel. If the pigmented bands were 1/4 to 2/5 the width of the entire nail, aesthetic repair of the nail was carried out by split-thickness excision under a microscope.ResultsThe average age of patients at the time of surgery was 14.5 years. Five patients had lesions on their toes, while three had lesions on their fingers. There were no post-operative complications. All toenails of the five patients who had undergone mimical reconstruction exhibited a well-settled flap. The nails of the three patients who underwent aesthetic repair displayed no nail malnutrition or deformity, and all nails had an aesthetic appearance.ConclusionsBoth mimical reconstruction and aesthetic repair of the nail following resection of subungual melanocytic nevus are reliable and feasible. The “like tissue” repairs of complex nail defects appear to be satisfactory. All patients had excellent aesthetic outcomes.Level of evidenceV

Nail Psoriasis and Quality-of-Life Measurement in Clinical Trials: Call for the Use of Nail-Specific Instruments.

Nail involvement is frequent in people with psoriasis. It can considerably impair health-related quality of life (HRQoL) beyond the impairments due to other psoriasis symptoms, for example, because patients feel ashamed of visible nail defects or because of the functional impairment in manual activities and walking. In clinical trials on nail psoriasis, it is therefore crucial to assess whether the treatment reduces HRQoL impairments that are specific to nail psoriasis. For this purpose, two validated patient questionnaires are available, the Nail Psoriasis Quality of Life Scale (NPQ10) and the Nail Assessment in Psoriasis and Psoriatic Arthritis–Quality of Life (NAPPA-QOL). The ten-item NPQ10 has the advantage of being short and thus quick to administer. The 20-item NAPPA-QOL, in contrast, assesses the different dimensions of HRQoL which is considered a multi-dimensional construct. Yet most randomized controlled trials on nail psoriasis do not evaluate HRQoL improvement. If they do, a number of different instruments are used, most of which are not nail specific. This makes comparison of trial outcomes difficult. Harmonizing the measurement of HRQoL in future clinical trials on nail psoriasis would improve comparability across studies and would also enhance the reliability of meta-analyses.

Nail matrix scars that result in nail dystrophy resemble cutaneous scars: A new nail trauma model

BackgroundFew studies have described how the injury affects the nail soft tissue under the nail plate. Nail matrix scar is poorly known. ObjectiveTo establish a stable rat nail loss model in a simple way, and to discuss the comparability of this model. MethodsA sterile cotton swab dipped in a 10% NaOH solution was used to burn the entire nail matrix and bed plane region, and the specimens were examined on day 3, 7, 14, and 28. ResultsAfter avulsion of the nail plate, the eponychia and matrix stuck together without any tissue destruction. On day 28, all claws of the experimental group were observed to be permanently damaged, except for one claw malformed regeneration.All impaired nail regeneration had deficiency or functional loss of NMSCs and shared similar characteristics with the cutaneous scars. ConclusionsThe scar formation of nail matrix was a fundamental reason to nail deficiency of rat or human, providing a research basis for further mechanism or treatment study of nail defect diseases.

Toe nail changes in diabetes mellitus

Introduction: Diabetes is a metabolic disorder caused by abnormal release of or sensitivity to the insulin hormone, with loss of blood glucose control. Un controlled diabetes can have devastating effects on many organ systems including cardiovascular, neurologic, ocular, and renal, with its impact on skin, hair, and nail. diabetes mellitus is a predisposing factor for onychomycosis (OM),paronychia and ingrowing toe nail defects. In the present study evaluation of the prevalence and types of nail changes was done. Materials and Methods: During a 1 year study period (June 2018 to May 2019), patients with diabetes mellitus were screened for toenail changes. Demographic, social, and clinical data were recorded. Informed written consent was taken. Fungal infection was confirmed by nail clippings microscopy. Results: Of the 60 patients most common nail changes are subungual hyperkeratosis, onycholysis, and onychomycosis, and less common changes are Twenty nail dystrophy, Dorsal pterygium, Terry’s nail in liver disease and diabetes mellitus and Subungual wart. Conclusions: Physicians who care for diabetic patients should not ignore nail changes. Careful global evaluation of patients with diabetes should include observation of nail changes. Keywords: Nails, Diabetes mellitus.

The Impact of Onychopathies on Quality of Life: A Hospital-based, Cross-sectional Study.

Background:Onychopathies or nail disorders are associated with social stigma and causes limitation of daily activities by hampering the function of both fingers and toes.Aim:To evaluate the impact of onychopathies on quality of life (QoL) and compare the severity of impact on QoL in various nail disorders.Materials and Methods:A hospital-based cross-sectional study consisting of 540 patients with onychopathies was conducted in the dermatology outpatient department. Patients were requested to complete a nail-specific QoL questionnaire consisting of 24 and 16 questions, respectively, for fingernails (group F) and toenails (group T) with five possible responses to each question. A score of 1-5 was given to each response. Statistical analysis was done to compare the impact of QoL on the different types of onychopathies.Results:We found that onychopathies have a significant impact on QoL. QoL was significantly more affected when multiple nails were involved (P = 0.020 for group F and P = 0.001 for group T). QoL impact was statistically more significant in women (P = 0.038 for group F and P < 0.001 for group T) and in younger people aged <20 years in group F and 20-39 years in group T (P < 0.001 for both groups F and T). Patients with onychomycosis, structural nail defects, and psoriasis had a more significant impact than other diseases (P < 0.001 for both groups F and T).Conclusion:Onychopathies have a significant adverse effect on QoL because of their serious physical, psychological and social impact. Hence, clinicians should treat the nail disorders with utmost seriousness.

Utility of dermoscopy in nail psoriasis: Its correlation with the Nail Psoriasis Severity Index (NAPSI) and psoriatic arthritis

Utility of dermoscopy in nail psoriasis: Its correlation with the Nail Psoriasis Severity Index (NAPSI) and psoriatic arthritis - IJCED- Print ISSN No: - 2581-4710 Online ISSN No:- 2581-4729 Article DOI No:- 10.18231/j.ijced.2019.026, IP Indian Journal of Clinical and Experimental Dermatology-IP Indian J Clin Exp Derma

Nail bed transplantation nourished by fascial flap pedicled with proper digital vessels for repair of nail defects

Objective To explore the clinical effects of nail bed transplantation combined with fascial flap pedicled with proper digital vessels in the treatment of nail defects. Methods From January 2012 to March 2016, 25 cases (27 fingers) of nail bed defects accompanied with phalangette periosteum defects were treated by nail bed transplantation combined with fascial flap pedicled with proper digital vessels. Results Postoperatively transplanted nail bed in 27 fingers survived. The patients were follow-up for 6 to 24 months with an average of 12.5 months. The nail appearance was satisfactory. According to the evaluation method issued by Lv Guixin et al, the curative effect of nail bed survival and nail shape was rated as excellent in 16 fingers, good in 9 fingers and poor in 2 fingers with the excellent and good rate being 92.6%. Conclusion The application of nail bed transplantation combined with fascial flap pedicled with proper digital vessels in the treatment of nail defects accompanied with phalangette periosteum defects can maximally restore the appearance and function of the nails. The postoperative clinical effects are satisfactory. Key words: Nails; Transplantation; Fascial flap; Repair

Complications in patients with intramedullary nails: a case series from a single Cambodian surgical clinic.

Since its development in 1999, the SIGN nail has been used in over 190,000 surgeries spanning 55 countries. To date, however, evaluation of SIGN nail outcomes has been limited to small prospective studies or large retrospective studies using SIGN's online database. This study uses the experience of a single, independent Cambodian surgical clinic to characterize common complications, provide commentary on ways to reduce the risk of those complications, and determine whether several observed nail fractures were due to metallurgic defects. Clinic medical records were queried to identify complications in patients with SIGN nails. Data was abstracted including age, sex, mechanism of injury, and latency between injury, primary implantation, and presentation with a complication. Two nails that fractured in vivo were analyzed by light microscopy, scanning electron microscopy, and polarized light microscopy after chemical etching. Fifty-four complications in 51 patients were identified. The most common complications were non-union (n = 26, 48%), infection (n = 16, 30%), flexion limitation (n = 11, 20%), nail fracture (n = 4, 7%), delayed union (n = 4, 7%), and malunion (n = 4, 7%). Other complications included broken or floating screws. Fractography revealed that two of the fractured nails most likely failed by fatigue followed by fast fracture at the site of non-union. We found no evidence of intrinsic nail defects. We identified multiple inconsistencies between SIGN's database and independent clinic records. Non-union and infection were common relative to all complications. Based on radiographic review, risk for non-union and malunion can be minimized by selecting an appropriate nail diameter, using multiple interlocking screws, and employing the correct implant and approach for fracture morphology when using SIGN nails. Nail fractures were unlikely to be caused by metallurgical flaws. Further study is necessary to determine the appropriate management of non-unions based on radiographic and clinical factors.

Living in the sub-sahara with anhidrotic ectodermal dysplasia: Report of two cases

Ectodermal dysplasia occurs worldwide. It is a hereditary disorder, and there are predominately two forms as follows: X-linked anhidrotic form and an autosomal dominant hidrotic form. It is mainly characterized by defects of the hairs which are sparse, nail defects, dental abnormalities, and the presence or absence of the eccrine glands. However, our cases had an abnormality of all four ectodermal structures. While they refused dental prosthesis, their major complaint had been heat intolerance which is a big treatment challenge in a hot climate as experienced in Kano Nigeria.

Incontinentia Pigmenti: A Summary Review of This Rare Ectodermal Dysplasia With Neurologic Manifestations, Including Treatment Protocols

Incontinentia pigmenti is a rare neuroectodermal dysplasia caused by a defect in the IKBKG gene (formerly known as NEMO). There are 27.6 new cases per year worldwide; 65% to 75% are sporadic mutations, and 25% to 35% are familial. It is usually lethal in males, but females survive because of X-inactivation mosaicism. The disorder is typically identified by unique skin findings, a series of four stages that emerge throughout the first year of life. The central nervous system manifestations in the eye and in the brain cause the most disability. Defects of hair, nails, and teeth occur, and there can be other systemic involvement. Surveillance protocols for medical management have been established by the Incontinentia Pigmenti International Foundation. This article will summarize the existing knowledge of this condition and detail the protocols to help manage the care of the infant or child who presents with incontinentia pigmenti.

Dentomaxillofacial characteristics of ectodermal dysplasia.

The aim of this retrospective hospital-based study was to elucidate the dentomaxillofacial characteristics of ectodermal dysplasia. Six Japanese individuals (one male and five female; age range, 12.7-27.2 years) underwent comprehensive examinations, including history recording, cephalometric analysis, panoramic radiography, and analysis of dental models. All the subjects had two or more major manifestations for clinical diagnosis of ectodermal dysplasia (e.g., defects of hair, teeth, nails, and sweat glands). They presented hypodontia (mean number of missing teeth, 9.5; range, 5-14), especially in the premolar region, and enamel dysplasia. Five subjects had bilateral molar occlusion, whereas one subject had unilateral molar occlusion. The common skeletal features were small facial height, maxillary hypoplasia, counterclockwise rotation of the mandible, and mandibular protrusion. Interestingly, the maxillary first molars were located in higher positions and the upper anterior facial height was smaller than the Japanese norm. The results suggest that vertical and anteroposterior maxillary growth retardation, rather than lack of occlusal support due to hypodontia, leads to reduced anterior facial height in individuals with ectodermal dysplasia.

Does nerve repair influence the outcome of reconstruction of a digital nail defect using a free composite flap taken from the great toe?

We describe reconstruction of a nail unit defect in the finger using a free composite flap taken from the great toe, comparing the outcome in patients in whom neurorrhaphy between the dorsal digital nerve of the great toe and the dorsal branch of the proper digital nerve of the injured finger was performed to those in which no nerve repair was made. From January 2002 to March 2009, 47 patients with traumatic fingernail defects were treated. Twenty-two patients before February 2005 had no nerve repair and subsequently 25 patients had nerve repair. The mean size of the germinal matrix and sterile matrix defects was 9 × 8 mm, and the mean size of the nail bed flaps was 9 × 9 mm. The mean length of the arteries used for the flap was 2.2 cm. Outcomes were rated. In the nerve repair group, full flap survival was achieved in 24 patients. At the mean follow-up period of 25 months, there were 12 excellent, seven very good, four good, and two fair results. In the comparison group without nerve repair, there were seven excellent, four very good, four good, five fair, and two poor results. Donor site morbidities were similar in both groups. The use of a free composite flap taken from the great toe is a useful technique for reconstructing nail unit defects in the finger. Innervated nail flap reconstructions tended to show better outcomes than those in which no nerve repair was performed. There is no difference in function or donor site between those in whom the nerve was repaired compared with those in whom it was not repaired.

Reconstruction of thumb and finger nail defects by using hallux toenail flap transplantation with dorsal branch of proper plantar artery anastomosis

Objective To evaluate the method and clinical effect of hallux toenail flap transplantation with dorsal branch of proper plantar artery anastomosis in the reparation thumb and finger nail defects.Methods From January 2010 to October 2012,three cases with thumb nail defects and 9 cases with finger nail defects were repaired by the hallux toenail flap transplantation.The dorsal branch of proper plantar artery of toenail flap was anastomosed with proper palmar digital artery or dorsal branch of proper palmar digital artery; using suture,dermatoplasty and hallux fibular flap to repair the donor site of hallux.Results All 12 cases of grafted hallux toenail flaps survived.All patients revealed favorable functions and growth of nail,nine cases of the grafted hallux toenail appearance was smooth and outline were satisfied,two case of the grafted hallux toenail was not smooth,one case of the grafted hallux toenail was obvious contracture and scar hyperplasia around the suture after 4-14 months followed-up,there was no abrasion to break happened in the area of dermatoplasty and flap.Conclusion It is a smaller injury and reliably method that using hallux toenail flap transplantation with dorsal branch of proper plantar artery anastomosis to repair the thumb and finger nail defects. Key words: Hallux toenail flap; Proper plantar artery; Thumb; Finger; Nail bed

Repair of a degloving injury of the thumb with a combined dorsal great toenail flap and dorsalis pedis flap: a case report

Many methods for the repair of degloving injuries of the thumb have been reported, but none are entirely satisfactory. Herein, we report a method in which the injury is divided into the dorsal and palmar area for repair. A great toenail flap is used to repair the dorsal injury to restore the nail defect, and a dorsalis pedis flap is used to repair the palmar injury. The described technique provides good restoration of morphology and aesthetic outcome, good functional and sensory recovery, and is associated with minimal donor-site morbidity.

Loss-of-Function Mutations in HOXC13 Cause Pure Hair and Nail Ectodermal Dysplasia

Pure hair and nail ectodermal dysplasia (PHNED) is a congenital condition characterized by hypotrichosis and nail dystrophy. Autosomal-recessive PHNED has previously been mapped to chromosomal region 12q12-q14.1, which contains the type II hair keratin and HOXC clusters. Hoxc13-null mice are known to develop hair and nail defects very similar to those seen in human PHNED. We performed whole-exome sequencing in a consanguineous Chinese family affected by PHNED and identified a homozygous nonsense mutation (c.390C>A [p.Tyr130(∗)]) in HOXC13 in all affected individuals. In an additional affected female from a consanguineous Afghan family, we found a 27.6 kb homozygous microdeletion involving the first exon of HOXC13. We examined HOXC13 expression in scalp specimen obtained from the index individual of the Chinese family and detected dramatically reduced mRNA levels in skin tissue and nearly absent protein staining in hair follicles, suggesting a mechanism of nonsense-mediated mRNA decay. We also observed markedly decreased expression of four HOXC13 target genes in the specimen. Taken together, our results demonstrate that loss-of-function mutations in HOXC13 cause autosomal-recessive PHNED and further highlight the importance of HOXC13 in hair and nail development.