In situ and split-thickness grafting for nail bed defects with bone exposure: A retrospective case series

Area of Science:

• Orthopedic Surgery
• Reconstructive Surgery
• Hand Surgery

Background:

• Nail bed defects with exposed bone are difficult to treat, often leading to spontaneous healing failure, flap coverage, or amputation.
• Standard treatments for such injuries carry significant risks and functional limitations.

Purpose of the Study:

• To evaluate the functional and aesthetic outcomes of nail bed defects repaired with in situ or split-thickness nail bed grafting.
• To assess the efficacy and safety of nail bed grafting as a reconstructive option.

Main Methods:

• A case series involving 28 patients (32 fingers) with nail bed defects and bone exposure from March 2019 to December 2023.
• Autologous nail bed grafting (in situ or split-thickness) was performed.
• Clinical outcomes were quantitatively assessed over a 12-month follow-up, including nail appearance, adherence, complications, and patient satisfaction.

Main Results:

• Excellent or good postoperative results were achieved in 90.6% (29/32) of the affected fingers.
• Four complications were noted, including three poor outcomes and one case with occupational dissatisfaction; one required a secondary procedure.
• No recurrent bone exposure, flap coverage, or digital amputation was necessary post-grafting.

Conclusions:

• Nail bed grafting presents a promising reconstructive strategy for select nail bed defects involving bone exposure.
• The procedure is technically straightforward, generally results in favorable nail growth, and has a low rate of major complications.
• Larger comparative studies are required to confirm these findings and establish definitive clinical indications.