Skip to main content

Secondary Reconstructive Options in Failed Fingertip and Nail Bed Injuries

  • Chapter
  • First Online:
Reoperative Hand Surgery

Abstract

Secondary reconstructive procedures for fingertip and nail bed injuries are frequently under appreciated by many surgeons. Complications from these injuries are not uncommon; however, many patients will just choose to live with their deformity. In other situations, the deformity with the fingertip injury leads to functional problems, and in these cases, the patient may seek out reconstructive options. These surgical efforts usually involve trying to make sure that the fingertip is covered with skin that has some sensation to it. It is also important that the skin be thick and durable to resist the significant forces placed upon it at the fingertip level. Just as important to the patient is the aesthetic and cosmetic appearance of the fingertip and nail; sometimes, this is even of greater concern to the patient than the functional deficits. This chapter discusses some of the reoperative options for dealing with failed fingertip and nail bed injuries.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Lewis BL. Microscopic studies of fetal and mature nail and surrounding soft tissues. AMA Arch Derm Syphilol. 1954;70:732–47.

    Article  Google Scholar 

  2. Brunelli F, Brunelli G. Vascular anatomy of the distal phalanx. The hand and upper limb 7. In: Foucher G, editor. Fingertip and nail bed injuries, vol. 17. Edinburgh: Churchill Livingstone; 1991. p. 1–9.

    Google Scholar 

  3. Flint MH. Some observation on the vascular supply of the nail bed and terminal segments of the finger. Br J Plast Surg. 1956;8:186–95.

    Article  Google Scholar 

  4. Zook EG, van Beek AL, Russel RC, et al. Anatomy and physiology of the perionychium: a review of the literature and anatomic study. J Hand Surg. 1980;5:528–36.

    CAS  Google Scholar 

  5. Zaias N, Alvarez J. The formation of the primate nail plate: an autoradiographic study in squirrel monkey. J Invest Dermatol. 1968;51:120–36.

    PubMed  CAS  Google Scholar 

  6. Slattery D, Aland R, Durbridge G, Cowin G. Dorsal digital septum of the distal interphalangeal joint. J Hand Surg. 2009;34A:467–73.

    Google Scholar 

  7. Strauch B, Moura W. Arterial system of the fingers. J Hand Surg. 1990;15A:148–54.

    Google Scholar 

  8. Ishikawa K, Ogawa Y, Soeda H, Yoshida Y. A new classification of the amputation level for the distal part of the finger. J Jpn Soc Reconstr Microsurg. 1990;3:54–62.

    Google Scholar 

  9. Tamai S. Twenty years’ experience of limb replantation—review of 293 upper extremity replants. J Hand Surg. 1982;7:549–56.

    CAS  Google Scholar 

  10. Hattori Y, Doi K, Ikeda K, Abe Y, Dhawan V. Significance of venous anastomosis in fingertip replantation. Plast Reconstr Surg. 2003;111:1151–8.

    Article  PubMed  Google Scholar 

  11. Hattori Y, Doi K, Sakamoto S, Yamasaki H, Wahegaonkar A, Addosooki A. Fingertip replantation. J Hand Surg. 2007;32A:548–55.

    Google Scholar 

  12. Hattori Y, Doi K, Ejiri S, Baliarsing AS. Replantation of very distal thumb amputations with pre-osteosynthesis interpositional vein graft. J Hand Surg. 2001;26B:105–7.

    Google Scholar 

  13. Kamei K, Shinokawa Y, Kishibe M. The venocutaneous fistula: a new technique for reducing venous congestion in replanted fingertips. Plast Reconstr Surg. 1997;99:1771–4.

    Article  PubMed  CAS  Google Scholar 

  14. Koshima I, Moriguchi T, Soeda S, et al. Free thin osteo-onycocutaneous flaps from the big toe for reconstruction of the distal phalanx of the fingers. Br J Plast Surg. 1992;45:1–5.

    Article  PubMed  CAS  Google Scholar 

  15. Han SK, Lee BI, Kim WK. Topical and systemic anticoagulation in the treatment of absent or compromised venous outflow in replanted fingertips. J Hand Surg. 2000;25A:659–67.

    Google Scholar 

  16. Gordon L, Leitner DW, Buncke HJ, Alpert BS. Partial nail removal after digital replantation as an alternative method of venous drainage. J Hand Surg. 1985;10A:360–4.

    Google Scholar 

  17. Hirase Y. Salvage of fingertip amputated at nail level: new surgical principles and treatments. Ann Plast Surg. 1997;38:151–7.

    Article  PubMed  CAS  Google Scholar 

  18. Koshima I, Yamashita S, Sugiyama N, Ushino S, Tsutsui T, Nanba Y. Successful delayed venous drainage in 16 consecutive distal phalangeal replantation. Plast Reconstr Surg. 2005;115:149–54.

    PubMed  CAS  Google Scholar 

  19. Gatewood MD. Plastic repair of finger defects without hospitalization. J Am Med Assoc. 1926;87:1479.

    Article  Google Scholar 

  20. Crikelair GF, Crowley RT, Miller H. Management of severe trauma to distal digital extremities. Am J Surg. 1953;85:322–6.

    Article  PubMed  CAS  Google Scholar 

  21. Bralliar F, Horner RL. Sensory cross-finger pedicle graft. J Bone Joint Surg. 1969;51A:1264–8.

    Google Scholar 

  22. Kutler W. A method for repair of finger amputation. Ohio State Med J. 1944;40:126.

    Google Scholar 

  23. Segmüller G. Modifikation des Kutler-Lappens: neuro-vaskulase stielung. Handchirurgie. 1976;8:75–6.

    PubMed  Google Scholar 

  24. Del Ben M, et al. Reverse dorsal digital island flap. Plast Reconstr Surg. 1994;93:552–7.

    Google Scholar 

  25. Maruyama Y. The reverse dorsal metacarpal flap. Br J Plast Surg. 1990;43:24–7.

    Article  PubMed  CAS  Google Scholar 

  26. Quaba AA, Davison PM. The distally-based dorsal hand flap. Br J Plast Surg. 1990;43:28–39.

    Article  PubMed  CAS  Google Scholar 

  27. Holevich J. A new method of restoring sensibility to the thumb. J Bone Joint Surg. 1963;45B:596–602.

    Google Scholar 

  28. Morrison WA, O’Brien BM, MacLeod AM. Thumb reconstruction with a free neurovascular wrap-around flap from the big toe. J Hand Surg. 1980;5A:575–83.

    Google Scholar 

  29. Doi K, Kuwata N, Kanai S. Reconstruction of the thumb with a free wrap-around flap from the big toe and an iliac crest graft. J Bone Joint Surg. 1985;67A:439–45.

    Google Scholar 

  30. May JW, Chait LA, Cohen BE, O’Brien BM. Free neurovascular flap from the first web of the foot in hand reconstruction. J Hand Surg. 1977;2A:387–93.

    Google Scholar 

  31. Morrison WA, O’Brien BM, Macleod AM, Gilbert A. Neurovascular free flaps from the foot for innervation of the hand. J Hand Surg. 1978;3A:235–42.

    Google Scholar 

  32. Bunkey Jr HJ, Rose EH. Free toe-to-finger tip neurovascular flaps. Plast Reconstr Surg. 1979;63:607–12.

    Article  Google Scholar 

  33. Foucher G, Merle M, Maneaud M, Michon J. Microsurgical free partial toe transfer in hand reconstruction: a report of 12 cases. Plast Reconstr Surg. 1980;65:616–27.

    Article  PubMed  CAS  Google Scholar 

  34. Kakinoki R, Ikeguchi R, Atiyya AN, et al. Treatment of posttraumatic painful neuromas at the digit tip using neurovascular island flaps. J Hand Surg. 2008;33A:348–52.

    Google Scholar 

  35. Shepard GH. Treatment of nail bed avulsions with split-thickness nail bed grafts. J Hand Surg. 1983;8:49–54.

    CAS  Google Scholar 

  36. Shepard GH. Management of acute nail bed avulsions. Hand Clin. 1990;6:39–56.

    PubMed  CAS  Google Scholar 

  37. Atasoy E, Godfrey A, Kalisman M. The “antenna” procedure for the “hook-nail” deformity. J Hand Surg. 1983;8:55–8.

    CAS  Google Scholar 

  38. Koshima I, Soed S, Takase T, et al. Free vascularized nail grafts. J Hand Surg. 1988;13A:29–32.

    Google Scholar 

  39. Koshima I, Moriguchi T, Soeda S, et al. Free second toe transfer for reconstruction of the distal phalanx of the fingers. Br J Plast Surg. 1991;44:456–8.

    Article  PubMed  CAS  Google Scholar 

  40. Koshima I, Moriguchi T, Umeda N, et al. Trimmed second toe tip transfer for reconstruction of claw nail deformity of the fingers. Br J Plast Surg. 1992;45:591–4.

    Article  PubMed  CAS  Google Scholar 

  41. Nakayama Y, Iino T, Uchid A, et al. Vascularized free nail raft nourished by arterialized inflow from the venous system. Plast Reconstr Surg. 1990;85:239–45.

    Article  PubMed  CAS  Google Scholar 

  42. Lundborg G. Tubular repair of nerves. In: Staffar P, Amadio PC, Foucher G, editors. Current practice in hand surgery. London: Martin Dunitz; 1997. p. 161–9.

    Google Scholar 

  43. Herbert TJ, Filan SL. Vein implantation for treatment of painful cutaneous neuromas. J Hand Surg. 1997;23B:220–4.

    Google Scholar 

  44. Kakinoki R, Ikeguchi R, Matsumoto T, et al. Treatment of painful peripheral neuromas by vein implantation. Int Orthop. 2003;27:60–4.

    PubMed  Google Scholar 

  45. Mackinnon SE, Dellon AL, Hudson AR, Hunter DA. Alteration of neuroma formation by manipulation of its microenvironment. Plast Reconstr Surg. 1985;76:345–53.

    Article  PubMed  CAS  Google Scholar 

  46. Kakinoki R, Ikeguchi R, Nankaku M, Nakamura T. Factor affecting the success of arterialized venous flaps in the hand. Injury. 2008;39 Suppl 4:18–24.

    Article  PubMed  Google Scholar 

Additional References

  • Bang H, Kojima T, Hayashi H. Palmar advancement flap with V-Y closure for thumb tip injuries. J Hand Surg. 1992;17A:933–4.

    Google Scholar 

  • Brunelli F, Vigasio A, Valenti P, Brunelli GR. Arterial anatomy and clinical application of the dorsoulnar flap of the thumb. J Hand Surg. 1999;24A:803–11.

    Article  Google Scholar 

  • Foucher G, Braun JB. A new island flap transfer from the dorsum of the index to the thumb. Plast Reconstr Surg. 1979;63:344–9.

    Article  PubMed  CAS  Google Scholar 

  • Foucher G, Merle M, Maneaud M. Microsurgical vascularized compound toe transfer for traumatic dorsal loss of the thumb. Plast Reconstr Surg. 1991;87:310–4.

    Article  PubMed  CAS  Google Scholar 

  • Han SK, Chung HS, Kim WK. The timing of neovascularization in fingertip replantation by external bleeding. Plast Reconstr Surg. 2002;110:1042–6.

    Article  PubMed  Google Scholar 

  • Koshima I, Soeda S, Moriguchi T, Higaki H, Miyakawa S, Yamasaki M. The use of arteriovenous anastomosis for replantation of the distal phalanx of the fingers. Plast Reconstr Surg. 1992;89:710–4.

    Article  PubMed  CAS  Google Scholar 

  • Leung PC. Thumb reconstruction using second-toe transfer. Hand Clin. 1985;1:285–95.

    PubMed  CAS  Google Scholar 

  • Lister GD, Kalisman M, Tsai TM. Reconstruction of the hand with free microvascular toe-to-hand transfer: experience with 54 toe transfers. Plast Reconstr Surg. 1983;71:372–86.

    Article  PubMed  CAS  Google Scholar 

  • Russell RC, Casas LA. Management of finger tip injuries. Clin Plast Surg. 1989;6:405–25.

    Google Scholar 

  • Tranquilli-Leali E. Riconstruzione dell’apice falangi; ungueall mediante autoplastica volare peduncolata per scorrimento. Infort Traumatol Lav. 1935;1:186–93.

    Google Scholar 

  • Yamano Y. Replantation of the amputated distal part of the fingers. J Hand Surg. 1985;10A:211–8.

    Google Scholar 

  • Yang D, Morris SF. Vascular basis of dorsal digital and metacarpal skin flaps. J Hand Surg. 2001;26:142–6.

    Article  CAS  Google Scholar 

  • Yoshimura M. Toe-to-hand transfer. Plast Reconstr Surg. 1980;66:74–84.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ryosuke Kakinoki MD, PhD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Kakinoki, R. (2012). Secondary Reconstructive Options in Failed Fingertip and Nail Bed Injuries. In: Duncan, S. (eds) Reoperative Hand Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-2373-7_21

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-2373-7_21

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-2372-0

  • Online ISBN: 978-1-4614-2373-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics