Distal fingertip amputations are often closed with a variety of flaps or grafts designed to manage the pulp defects palmarly and to provide coverage of the tuft distally. However, transverse amputations also produce a defect in the sterile matrix and the nail plate, which is difficult to restore. The resultant nail plate is often foreshortened by the loss of distal sterile matrix, producing a significant cosmetic deformity. The authors previously described a dorsal eponychial flap, which they used in the 30 cases presented in this paper. All of the patients suffered transverse amputations with loss of the tip and exposure of the nail matrix. The distal defects were closed with V-Y advancement flaps. The nail plates were treated with a proximal advancement flap of eponychium transferred over de-epithelialized eponychium.
The operative time for flap dissection was brief, averaging 13 minutes. All flaps healed and effectively lengthened the area of visible nail plate, correcting the perception of a foreshortened nail. The injured fingers healed with nail plates ranging from 85 to 108% of the contralateral digits. The results of this flap appear to be satisfactory and solve the problem of shortened nail plates in transverse partial fingertip amputation. Nail growth does not appear to be adversely affected. The diagrams in the article are rather simplistic and hard to understand; accurate color photographs would better illustrate the technique for the first-time user. However, the technique appears to be straightforward and quick once learned, and the results are satisfactory in these 30 cases. Secondary scarring of the eponychium in delayed repair is a contraindication, interfering with the safe transfer of the flap and interfering with its vascular supply.
Plastic and Reconstructive Surgery