Distraction Osteogenesis and Free Nail Graft After Distal Phalanx Amputation

Service of Hand Surgery and Reconstructive Microsurgery, Hospital São Lucas da Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil. Electronic address: .
The Journal of hand surgery (Impact Factor: 1.66). 12/2012; 37(12):2541-6. DOI: 10.1016/j.jhsa.2012.09.008
Source: PubMed

ABSTRACT To describe the results in patients treated with distraction osteogenesis combined with free nail graft after distal phalanx amputation.
We analyzed 14 patients with distal phalanx amputation (13 women). Mean age was 35 years. There were 9 amputations of the index finger, 3 of the middle finger, and 1 each of the thumb and ring finger. We started bone distraction 7 days after surgery, with 1 mm distraction every 3 days. After bone elongation, we inserted a free composite nail graft at the dorsal tip of the distracted finger. We evaluated distraction length, consolidation time, aesthetic result (using the Foucher and Leclère score), and complications.
The mean bone elongation was 17 mm and mean consolidation time was 149 days. Nail cosmetic results were satisfactory; the mean total Foucher score was 14 out of 20. Mean individual scores were patient's opinion (7.8 out of 10), adequate length (1.2 out of 2.5), adequate alignment (1 out of 1), adequate width (1.8 out of 4), and dorsal scar quality (2.2 out of 2.5). The mean total Leclère score was 14 out of 20. All patients retained sensibility in the grafted area and none had healing abnormalities. The mean opinion about the donor site was 7.5 out of 8. Nail growth less than 50% occurred in 2 patients. Mean follow-up was 62 months.
Distraction osteogenesis combined with free nail graft is a therapeutic option when replantation is not an option or when it fails. However, treatment takes time and requires the involvement of the patient, family, and medical team.
Therapeutic IV.

Download full-text


Available from: Jefferson Braga Silva, Jul 05, 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: We have reported three cases of vascularized nail flap transfer with a short pedicle to the index and little fingers. We consider that reconstruction of fingers should be conducted positively even in the case of the nail defect except the thumb, if a patient desires. Since these operations are aimed at cosmetic improvement, reconstruction with a short pedicle seems to be the method worth employing because it leaves short skin incisions.
    Plastic &amp Reconstructive Surgery 04/1996; 97(3):656-61. DOI:10.1097/00006534-199603000-00028 · 3.33 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Reconstruction of congenital differences of the hand presents a surgical challenge. Microsurgical toe-to-hand transfer is becoming an accepted treatment for these difficult problems. These transfers can provide functionally useful and cosmetically acceptable digits in children with congenital absence of the thumb, fingers, or both. Currently, the success rate is routinely greater than 95%.
    Hand Clinics 03/2007; 23(1):129-36. DOI:10.1016/j.hcl.2007.02.006 · 1.07 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Free, nonvascularized composite nail grafts have been reported as a successful method to reconstruct nail deformities due to congenital anomalies or traumatic defects. The authors performed a decade review of their experience with nine patients who had had 10 free, nonvascularized composite nail grafts. Patient demographics, mechanism of injury, timing, site of reconstruction, and amount of nail to be replaced were all recorded. Results of nail growth in reconstructed nails were judged as excellent, good, fair, or poor on the basis of the appearance of the nail. The majority of reconstructed nails had half or more of the nail bed replaced. The 10 cases (mean follow-up of 1.8 years) that were reported had two excellent, three good, two fair, and three poor outcomes. There was no apparent relation between the successful outcome of the procedure and patient age, timing of reconstruction, or amount of nail bed replaced. Although the authors' experience suggests the unpredictable nature of this type of graft, it should be considered for patients who desire nail reconstruction and are not candidates for ablative or vascularized nail complex transfer procedures.
    Plastic &amp Reconstructive Surgery 07/2000; 105(7):2412-5. DOI:10.1097/00006534-200006000-00016 · 3.33 Impact Factor
Show more