Chronic Posttraumatic Nail Reconstruction with an Eponychium Flap: Technique Description and Case Series.

PURPOSE: Fingertip trauma and amputations, when not treated correctly, can evolve unfavorably, leading to pain, loss of strength, and tactile difficulties. Post-traumatic nail changes are not just a cosmetic complaint as the nail, along with its protective function, also helps to stabilize the fingertip, adding to pinching motion. There are techniques that provide the nail complex improvement for the treatment of post-traumatic sequelae, thus enhancing fingertip function and aspect.

METHODS

We have used a rectangular, eponychium flap with an indentation in the eponychial fold that increases the exposure of the nail matrix in a series of 19 digits in 18 patients. The indication was pain, deformity, and post-traumatic shortening of the nail, for at least 3 months after the initial injury.

RESULTS

The size of the flap and consequent nail size increase averaged 3.44 mm. There were no instances of necrosis or any other serious complication requiring a second procedure. Regarding function satisfaction, 11 patients regarded the results as excellent; six reported good outcomes; and one had a fair result. As for appearance, 11 considered the results as excellent, and seven as good.

CONCLUSION

We conclude that the eponychium flap performed to increase the size and improve the shape of the nail is a safe, reproducible procedure that generates good cosmetic and functional results, presenting a low rate of complications. It poses few risks and can be associated with the volar flap for pulp reconstruction, without any result change.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.