title: Thumb fingertip reconstruction with palmar V-Y flaps combined with bone and nail bed grafts following amputation.
abstract: BACKGROUND
  The aim of treating thumb fingertip amputations with no indication for replantation is to reestablish functional and esthetic properties.
  
  
  METHODS
  From March 2005 to October 2008, we treated 14 patients with thumb fingertip amputation using palmar V-Y flaps combined with bone and nail bed grafts. There were 10 men and 4 women, whose ages at surgery ranged from 19 to 63 years (mean 35.8 years). In all, 11 of the injuries occurred in the dominant hand. According to Allen's classification, two were type II, seven were type III, and five were type IV. All patients underwent emergency surgery, with a time delay after injury of 3-12 h (mean 6.4 h). In each case, the amputation was a crush or avulsion injury, making microsurgical replantation not feasible.
  
  
  RESULTS
  All of the flaps survived. At 8-17 months (average 12.8 months) of follow-up, the average subjective satisfaction score was 8.64. All patients experienced cold intolerance, and none of the patients complained of dysesthesia. Favorable results (excellent or good) were found in 78.6%. Thin primary nails appeared on the grafted nail bed about 3 weeks after surgery, following which the newly formed nail thickened and developed a more natural appearance. In one case, the new nail plate showed abnormal thickening due to hyperkeratosis. The bone graft healed at 5 weeks. The mean two-point discrimination was 7.5 mm. Grip strength was 10% less than that in the unaffected hand. Metacarpophalangeal and proximal interphalangeal joint mobility losses were less than 10°. All patients returned to their jobs. No patients had postoperative complications.
  
  
  CONCLUSIONS
  We believe that the combination of palmar V-Y flap and bone and nail bed grafts provides a distinct advantage over other choices. It improves function when replantation is not an option.
authors: Department of Hand Surgery, The Ninth People's Hospital of Wuxi City, Suzhou University, No.999 Liangxi Road, Wuxi, 214062, China.
authors: Xiao
authors: X
authors: Zhou
authors: Libo
authors: L
authors: Wang
authors: Jingyi
authors: J
authors: Mi
authors: Yajun
authors: Y
authors: Xu
authors: Yongjun
authors: Y
authors: Rui
authors: Mingyu
authors: M
authors: Xue
authors: Xiaofang
authors: X
authors: Shen
authors: Li
authors: L
authors: Qiang
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009262:Nails / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D013933:Thumb / Q000293:injuries / Q000601:surgery*; D055815:Young Adult