title: Distraction osteogenesis and free nail graft after distal phalanx amputation.
abstract: OBJECTIVE
  To describe the results in patients treated with distraction osteogenesis combined with free nail graft after distal phalanx amputation.
  
  
  METHODS
  We analyzed 14 patients with distal phalanx amputation (13 women). Mean age was 35 years. There were 9 amputations of the index finger, 3 of the middle finger, and 1 each of the thumb and ring finger. We started bone distraction 7 days after surgery, with 1 mm distraction every 3 days. After bone elongation, we inserted a free composite nail graft at the dorsal tip of the distracted finger. We evaluated distraction length, consolidation time, aesthetic result (using the Foucher and Leclère score), and complications.
  
  
  RESULTS
  The mean bone elongation was 17 mm and mean consolidation time was 149 days. Nail cosmetic results were satisfactory; the mean total Foucher score was 14 out of 20. Mean individual scores were patient's opinion (7.8 out of 10), adequate length (1.2 out of 2.5), adequate alignment (1 out of 1), adequate width (1.8 out of 4), and dorsal scar quality (2.2 out of 2.5). The mean total Leclère score was 14 out of 20. All patients retained sensibility in the grafted area and none had healing abnormalities. The mean opinion about the donor site was 7.5 out of 8. Nail growth less than 50% occurred in 2 patients. Mean follow-up was 62 months.
  
  
  CONCLUSIONS
  Distraction osteogenesis combined with free nail graft is a therapeutic option when replantation is not an option or when it fails. However, treatment takes time and requires the involvement of the patient, family, and medical team.
authors.affiliation: Service of Hand Surgery and Reconstructive Microsurgery, Hospital São Lucas da Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil. jeffmao@terra.com.br
authors.forename: Jefferson
authors.initials: J
authors.lastname: Braga-Silva
authors.forename: Alexandre V
authors.initials: AV
authors.lastname: Padoin
mesh_terms: D000293:Adolescent; D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D016025:Bone Transplantation; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009262:Nails / Q000637:transplantation*; D019857:Osteogenesis, Distraction; D012189:Retrospective Studies; D055815:Young Adult