The Top-Hat Flap: A New Technique for Segmental Nailbed Reconstruction

Area of Science:

• Hand surgery
• Reconstructive surgery
• Microsurgery

Background:

• Complex injuries to the finger or thumb tip often involve segmental defects of the distal phalanx, nailbed, or pulp.
• Reconstruction of these defects is crucial for restoring function and appearance.
• The homodigital neurovascular island flap, or "top-hat flap," is a technique used for fingertip reconstruction.

Purpose of the Study:

• To evaluate the efficacy of the top-hat flap in reconstructing segmental defects of the finger or thumb tip.
• To assess functional outcomes, including range of motion, sensory recovery, and return to work.
• To determine the average digit impairment score following this reconstructive procedure.

Main Methods:

• A retrospective review of 28 patients who underwent top-hat flap reconstruction for fingertip defects over a 7-year period.
• Minimum follow-up of 12 months.
• Assessment of flap survival, fracture union, range of motion, 2-point discrimination, return to work, and digit impairment score.

Main Results:

• All 28 top-hat flaps survived, and all fractures united.
• 75% of patients achieved full range of motion at the distal interphalangeal joint.
• 71% achieved 2-point discrimination of less than 6 mm, and 92% returned to their preinjury job within 3 months.
• The average digit impairment score was 19%.

Conclusions:

• The top-hat flap is a successful reconstructive option for complex finger and thumb tip injuries with segmental defects.
• It provides good functional and sensory recovery, facilitating an early return to work.
• This technique is a valuable tool for plastic and hand surgeons managing fingertip trauma.