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Primary reconstruction of fingernail injuries in children with split-thickness nail bed grafts
Imke Rohard1, Ulrike Subotic, Daniel Max Weber
1Department of Pediatric Hand Surgery, University Children's Hospital Zurich, Zurich, Switzerland. imke.rohard@kispisg.ch
Insights
Split-thickness nail bed grafts (STNBGs) effectively treat complex pediatric nail bed injuries, yielding good cosmetic and functional outcomes and preventing future deformities.
Area of Science:
- Hand surgery
- Pediatric reconstructive surgery
- Nail bed reconstruction
Background:
- Nail bed injuries can cause significant deformity and functional impairment.
- Current treatment options for pediatric nail bed injuries are limited, with no published pediatric series on split-thickness nail bed grafts (STNBGs).
Observation:
- A retrospective case series of nine pediatric patients with complex nail bed injuries treated with STNBGs was conducted.
- Grafts were harvested from the injured finger or the great toe.
- Six cases required additional flap coverage due to insufficient vascularization.
Findings:
- All STNBGs achieved a 100% take rate.
- One patient required reoperation for nail deformity; others had satisfactory outcomes.
- High patient satisfaction was reported across the series.
Implications:
- STNBGs are a reliable method for reconstructing complex pediatric nail bed injuries.
- This technique can prevent secondary nail growth disturbances and improve cosmetic and functional results.
- Further research into STNBG for pediatric nail bed reconstruction is warranted.
Introduction:
Failure to detect and treat partial or complete avulsions of the nail bed may lead to severe nail deformity that predisposes to repeat injuries and is cosmetically inacceptable. Treatment of these injuries with split-thickness nail bed grafts (STNBGs) is controversial and no pediatric series has been published.
Methods:
A retrospective, single center case series of nine fingers with complex nail bed injuries that were reconstructed primarily with STNBGs was performed. Surgical outcome and patient satisfaction were assessed.
Results:
For six nail bed reconstructions, the nail bed graft was harvested from the injured finger, and for the remaining three from the great toe. Harvesting of the great toe's nail bed could be performed without removal of the nail plate by only lifting it up distally. Insufficient vascularization required primary flap coverage in six cases with three Moberg flaps, two palmar V-Y flaps, and one thenar flap. No flap was lost and all nail bed grafts had a 100% take. Only one patient required reoperation due to a hook- and split-nail deformity. All other patients were satisfied or very satisfied and the surgical outcome was least satisfactory in all but two patients.
Conclusions:
Primary reconstruction of complex nail bed injuries with STNBGs usually gives good cosmetic and functional results in children and prevents secondary nail growth disturbances reliably.
