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  • Title: [Repair of severe nail bed defects with radial dorsal fasciocutaneous flap of thumb].
    Author: Liu Y, Ding X, Jiao H, Zhang H, Qu Z, Jiang K, Cao X.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2013 May; 27(5):603-5. PubMed ID: 23879101.
    Abstract:
    OBJECTIVE: To summarize the effectiveness of radial dorsal fasciocutaneous flap of thumb for repairing severe nail bed defects. METHODS: Between May 2009 and January 2012, 16 patients with severe nail bed defect were treated with radial dorsal fasciocutaneous flap of the thumb. There were 10 males and 6 females, aged 16-54 years (mean, 36 years). The causes of injury included crush injury in 10 cases, chainsaw injury in 4 cases, and scald in 2 cases; injured fingers were thumb in 3 cases, index finger in 4 cases, middle finger in 5 cases, ring finger in 3 cases, and little finger in 1 case. The time between injury and operation was 2 hours to 8 days (mean, 19.3 hours). Of 16 patients, 9 complicated by distal phalanx fracture. The area of defect ranged from 0.9 cm x 0.6 cm to 2.3 cm x 2.1 cm. According to ZHOU Qingwen's grading system for nail bed defects, 6 cases were rated as degree III and 10 cases as degree IV. The area of flap ranged from 1.0 cm x 0.6 cm to 2.5 cm x 2.2 cm. Retrograde transposition was performed to repair the thumb defect, and pedicled transposition to repair the 2nd-5th fingers defects. The donor sites were directly sutured or were repaired with skin graft. RESULTS: All flaps and skin grafts survived, and wounds healed by first intention. All patients were followed up 6-12 months (mean, 8 months). The color, texture, and contour of the flaps were good. According to total active motion standard, the finger function was assessed as excellent in 10 cases, good in 4 cases, and fair in 2 cases, and the excellent and good rate was 87.5%. CONCLUSION: Radial dorsal fasciocutaneous flap of thumb is a reliable flap with easy dissection and less trauma in repair of severe nail bed defects.
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