Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
J Trauma Acute Care Surg. 2012 May;72(5):1424-8. doi: 10.1097/TA.0b013e3182478c5e.
Nail fold deformities from burn injury frequently result in eponychial retraction, proximal nail exposure, pain, and distal phalangeal function impairment. Secondary nail abnormalities including longitudinal ridges, surface cracks, and fragility are common sequelae to nail fold deformities. Surgical management of postburn nail fold deformity is challenging because of scar contractures involving the dorsum of digits and lack of surrounding healthy tissues that can be used as source of soft tissue for reconstruction. Previous reports have discussed several methods for reconstruction of these deformities. However, all of these methods are associated with significant donor site morbidities.
From August 2008 to January 2010, "onion" flap reconstruction was performed for postburn nail fold contractures and deformities on 32 fingers of eight patients (five men and three women; average age, 44.4 years; age range, 23-54 years). This novel technique was used to release scar contractures in the eponychial area and allow soft tissue restoration by redraping the eponychium in a single-step procedure. All 32 fingers received single-stage "onion" flap reconstruction for their nail fold deformities at least 6 months after the initial injury.
The follow-up period, with an average of 7.8 months, revealed that all nails had good esthetic and functional results. All experienced amelioration of nail abnormalities. The "onion" advancement flap had effectively released the scar contracture around the nail fold and simultaneously restored the eponychial fold.
The "onion" flap technique provides superior results compared with those from conventional techniques. We recommend it as the mainstay of treatment for reconstruction of the postburn eponychial deformities.
V, therapeutic study.
烧伤导致的甲襞畸形常导致甲上皮回缩、近端甲外露、疼痛和末节指骨功能障碍。甲床畸形的常见后遗症包括纵向嵴、表面裂纹和脆性等继发性甲异常。由于涉及指背的瘢痕挛缩和缺乏可用于重建的周围健康组织，烧伤后甲床畸形的手术治疗具有挑战性。既往报道了几种重建这些畸形的方法。然而，所有这些方法都与显著的供区并发症相关。
2008 年 8 月至 2010 年 1 月，8 例患者（5 名男性，3 名女性；平均年龄 44.4 岁；年龄范围 23-54 岁）的 32 个手指因烧伤后甲床挛缩和畸形行“洋葱瓣”皮瓣重建。该新技术用于释放甲上皮区域的瘢痕挛缩，并通过单次手术重新覆盖甲上皮来允许软组织修复。所有 32 个手指在初次受伤至少 6 个月后，均接受了单阶段“洋葱瓣”皮瓣重建以矫正甲床畸形。
平均随访 7.8 个月，所有指甲均具有良好的美学和功能结果。所有患者的甲异常均得到改善。“洋葱瓣”推进瓣有效松解了甲床周围的瘢痕挛缩，同时修复了甲上皮皱襞。
与传统技术相比，“洋葱瓣”皮瓣技术提供了更好的结果。我们建议将其作为重建烧伤后甲上皮畸形的主要治疗方法。
V，治疗性研究。
