Nailfold reconstruction for correction of burn fingernail deformity.

Abstract

Fingernail deformities frequently occur after burn injury to the hand. In many cases, the deformity is not the result of injury to the nail bed or germinal matrix but is instead secondary to contracture of soft tissues proximal to the eponychium. The roof of the nailfold peels away from the nail, causing abnormal nail growth and appearance. Alterations in appearance can range from subtle changes in contour and location of the eponychium to complete loss of germinal matrix and absence of nail growth. The majority of patients fall into a midrange category that includes multiple symptoms. The important concept, however, is that in many cases the complex structure of the nailfold is not destroyed by the injury but is only displaced by the proximal contracture.
This deformity is readily treatable with a simple, reliable procedure that releases the proximal contracture with a distally based bipedicled flap and resurfacing with a skin graft.
Contracture release allows the displaced and everted roof of the nailfold to slide distally without tension and restores normal nailfold anatomy. The contribution of the dorsal nail matrix to nail growth is restored, improving fingernail appearance and function. Over the past 20 years, this technique has been used in over 100 digits with burn fingernail deformities. There have been no instances of flap loss.
This is a simple, straightforward procedure, with few complications, that relieves many symptoms associated with burn fingernail deformity. Thousands of burned digits would benefit from this procedure.