Académique Documents
Professionnel Documents
Culture Documents
UNIT RECONSTRUCTION
Christian Dumontier
Service de Chirurgie de la Main, Chirurgie Plastique, Reconstructrice et Esthétique, Nice
Thermal exchanges
Esthetic +++
Appareil extenseur
Ligament inter-osseux
latéral de Flint
Ligament hyponichial
AND ITS ADJACENT LIGAMENTOUS
STRUCTURES
A proximal fibrous nucleus with the mixing of fibers from the extensor, the
flexor, the collateral ligament
A proximal fibrous nucleus with the mixing of fibers from the extensor, the
flexor, the collateral ligament
No hypodermic tissue
THE NAIL PLATE
The peryonychium:
The paronychium:
Hyponychium
THE NAIL MATRIX
zone
A. distale
A. proximale
A. collatérale palmaire
Very rich
Associated lesions
Pulp: 26,7%
Small instruments
A freer elevator
Loupes
Hook-nail deformity
Hyponychial loss
Absence of nail
Loss of the supportive tissues
Hook-nail deformity
Volar inclination of the nail is secondary to:
Bone loss
Pulp retraction/loss
Treatment can only be surgical
Possible surgical techniques
Foucher’s variation
11/16 cases, 50% good results
Quality of results was correlated to
the importance of bone loss
Interesting in case of scarring pulp
Texte
Limited results due
to undersizing of
the pulp with
secondary
retraction
28 patients, 1/3 excellent,
1/3 good, 1/3 fair
Results were correlated to
bone loss, the cutting edge
being 50% bone loss
It is important to over-
estimate the skin loss to
prevent recurrence due to
secondary flap retraction
Depends of :
Bone loss: < 50% (soft-tissue), > 50% consider
microsurgery if:
Pulp loss
Thumb (> finger)
Local vascularity (Age +++, smoker)
Functional needs (Musicians, ...)
HYPONYCHIAL LOSS
Very frequent
Patient complains of
pain when pulling on
their pulp or when
trying to cut their nails
HYPONYCHIAL LOSS
Treatment is easy:
remove the distal scar at
the end of the nail bed
Two tricks: graft the donor site + nail bed graft on the
inferior part of the nail fold +++
Some examples
Split-thickness graft of a nail wall
for treatment of a pterygium
NAIL BED
RECONSTRUCTION
NAIL BED INJURIES
Onycholysis
Splints, grooves
Oversized graft
2 years
Distal onycholysis
treated with nail bed
graft
RESULTS OF NAIL BED GRAFTS
3 yrs
4 published series (< 10 cas)
Double treatment:
Do we need one ?
ABSENCE OF NAIL
Stump amputation
Skin grafts
Nail prosthesis
Now abandoned
Prevention
1 month results
Example of a desepidermized Atasoy’s flap to
reconstruct a distal nail bed loss: easy and sufficient
DO NOT FORGET