Department of Microsurgery and Hand Surgery, Longgang Orthopedics Hospital of Shenzhen, Shenzhen Guangdong Province, People's Republic of China.
Department of Microsurgery and Hand Surgery, Longgang Orthopedics Hospital of Shenzhen, Shenzhen Guangdong Province, People's Republic of China.
J Hand Surg Am. 2020 Sep;45(9):879.e1-879.e10. doi: 10.1016/j.jhsa.2020.02.018. Epub 2020 Apr 13.
We report a surgical procedure for the management of nail bed injuries combined with soft tissue defects.
We reviewed the records of patients with a nail bed injury combined with a soft tissue defect, who were surgically treated at our hospital from 2015 through 2018. According to the Allen classification, 5 patients were characterized as type 2 and 3 were characterized as type 3. Two also had partial defects of the distal phalanx. In all cases, we created a split-thickness nail bed flap of the great toe to reconstruct the nail bed injury. All patients underwent supervised postoperative rehabilitation. We reviewed patients' medical records for the Michigan Hand Outcomes Questionnaire, 2-point discrimination, and postoperative healing in the donor area.
Both the nails and flaps of all patients survived. No complications were observed after surgery. The nail was completely attached to the nail bed. In addition, there were no deformities, and the nail plate appearance was close to normal. A nail with an unsatisfactory appearance was noted in one patient. The shape, texture, and elasticity of the flaps of all patients were acceptable. All patients were capable of normal pinching, gripping, and grasping. Twelve months after the operation, 3 of 8 patients had 2-point discrimination of 6 mm or less. All patients were satisfied with the hand function according to the Michigan Hand Outcomes Questionnaire. The toenail of the donor site grew well, and no deformity or pain with walking was noted.
We demonstrate that this approach is a safe means of repairing a nail bed injury combined with a soft tissue defect.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.
我们报告一种治疗甲床损伤合并软组织缺损的手术方法。
我们回顾了 2015 年至 2018 年在我院接受手术治疗的甲床损伤合并软组织缺损患者的病历。根据 Allen 分类，5 例为 2 型，3 例为 3 型。其中 2 例还伴有远节指骨部分缺损。所有患者均采用大脚趾部分甲床皮瓣游离移植修复甲床损伤。所有患者均接受术后康复治疗。我们查阅了患者的密歇根手功能问卷、2 点辨别觉和供区术后愈合情况的病历记录。
所有患者的指甲和皮瓣均存活。术后无并发症。指甲完全附着在甲床上。此外，无畸形，指甲外观接近正常。1 例患者指甲外观不满意。所有患者的皮瓣形状、质地和弹性均满意。所有患者均能正常捏、抓和握持。术后 12 个月，8 例患者中有 3 例 2 点辨别觉小于 6mm。所有患者均根据密歇根手功能问卷对手部功能满意。供区的趾甲生长良好，行走时无畸形或疼痛。
我们证实，这种方法是修复甲床损伤合并软组织缺损的一种安全方法。
研究类型/证据水平：治疗性 V 级。
