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

SUMMARY: The finger or thumb tip was used as a homodigital neurovascular island flap ("top-hat flap") to reconstruct 28 segmental defects of the distal phalanx, nailbed, or pulp over a 7-year period with a minimum follow-up of 12 months. All flaps survived and all fractures united. A total of 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 unrestricted to their preinjury job less than 3 months after injury. The average digit impairment score, based on the American Medical Association's Guides to the Evaluation of Permanent Impairment, Fifth Edition , was 19%. The top-hat flap is an option for the treatment of complex injuries of the finger or thumb tip where there is a segmental defect in the nailbed, distal phalanx, or pulp and a neurovascularly intact finger or thumb tip.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.