PURPOSE: Fingertip amputations affect the distal phalanx, pulp, and nail complex, with considerable impact on both function and appearance. Although various flap techniques are used for soft-tissue coverage, restoration of apparent nail-plate exposure is often neglected. This study aimed to compare the functional and aesthetic outcomes of two apparent nail-plate exposure techniques, the rectangle recession flap and the eponychial folding flap, in patients with fingertip amputations. Neither technique creates new nail tissue; both modify the proximal nail-fold to expose a greater proportion of the already-present nail-plate.
METHODS: This was a prospective comparative study conducted from June 2023 to June 2024 at a tertiary care specialty hospital. Sixty patients with fingertip amputations were randomized using sequentially numbered, opaque, sealed envelopes into the rectangle recession flap group (group A, n = 30) or the eponychial folding flap group (group B, n = 30). A biostatistician was involved in both sequence generation and statistical validation. Patients were assessed at regular intervals over a 3-month postoperative period. Primary outcome measures included apparent gain in visible nail-plate exposure (as a percentage of the contralateral normal), scar quality, sensation, and overall aesthetic satisfaction using validated scoring systems.
RESULTS: The study revealed significant differences between the two techniques in terms of apparent gain in visible nail-plate exposure and functional outcomes. Patients who underwent the eponychial folding flap technique demonstrated superior outcomes, particularly in terms of visible nail-plate exposure, scar quality, appearance, and postoperative pain.
CONCLUSIONS: Both techniques are viable options for increasing apparent visible nail-plate exposure in fingertip reconstruction; however, the eponychial folding flap provides superior outcomes in terms of visible nail-plate exposure, scar quality, and aesthetic restoration, and may be preferred in appropriate cases.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Read the article: PubMed · Publisher (DOI)