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Functional and Aesthetic Outcomes of the Fingertips after
Nail Lengthening Using the Eponychial Flap
Hsin-Yu Chen, MD; Chung-Chen Hsu, MD; Yu-Te Lin, MD; Chih-Hung Lin, MD; Cheng-Hung Lin, MD

Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan

Introduction: The fingernail is important for the aesthetic appearance and pulp stability. Fingertip amputations with nail bed involvement complicate reconstruction and may influence the choice of treatment. Eponychial flap technique is able to lengthen the visible nail and allow preservation of the nail complex. The goal of this study was to comprehensively assess the functional and aesthetic outcomes of the reconstructed fingertips using the eponychial flap.

Patients and Methods: This study evaluated the eponychial flap technique in 11 fingertip amputations (study group). Nine patients with similar fingertip amputations treated with stump revision and nail complex ablation were also included (comparison group). The mean injured nail length was 32.9% of the contralateral normal side. Using the eponychial flap, the visible nail bed can be lengthened immediately by 31.9% of its normal length. Subjective pain and discomfort, two-point discrimination (2PD), Semmes-Weinstein monofilament (SWM) test, Purdue dexterity test, and pinch power of the reconstructed fingers were evaluated. Patient-reported outcomes including Michigan Hand Outcome Questionnaire (MHQ) and visual analogue scale (VAS) for finger appearance were also recorded.

Results: At a mean follow-up of 26 months, the mean reconstructed nail length was 70.8% of the contralateral side. Using the contralateral unaffected finger as a reference, the study group showed greater pinch power (102% vs. 64%, p = 0.004) than the comparison group. The mean appearance rating for the reconstructed fingers on a scale of 1 to 10 was 7.5 in the study group and 5.9 in the comparison group (p = 0.031). There were no significant differences in subjective discomfort, 2PD, SWM results, or dexterity testing between two groups. Patient treated with the eponychial flap demonstrated higher mean MHQ scores in overall hand function and satisfaction. Patient satisfaction is correlated with the reconstructed nail length (p= 0.021). Patients may feel satisfied if the restored nail achieves 55% of its normal length.

Conclusion: The eponychial flap is a simple and safe technique that can restore a functional and aesthetic fingertip in selected distal phalanx amputations. The aesthetic outcomes, pinch power, and patient satisfaction are significantly better while fingernail lengthening using the eponychial flap.

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