The Use of Composite Bone and Nail Bed Graft Combined With Cutaneous Flaps for Reconstruction of Finger Tip Amputations

NCT ID: NCT05961891

Last Updated: 2023-07-27

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 30 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-07-10
• Study Completion Date: 2024-06-10

Brief Summary

Fingertip injuries are among the most common hand injuries regardless of age, as the fingertip is a prominent and frequently used part of the hand. However, no consensus yet exists regarding the ideal reconstruction of fingertip injuries with nail bed defects, and its reconstructive methods are limited.

Allen has classified fingertip amputations into four types. Type I injuries involve only the pulp of the finger. Type II includes pulp and nail loss. Type III has partial terminal phalanx loss and corresponding pulp and nail loss. Finally, type IV involves the lunule of the nail, pulp, nail, and partial loss of the terminal phalanx.

Fingertip amputations through the proximal half of the nail-bed are challenging as the remaining nail-bed has inadequate length for satisfactory nail growth. Replantation at this level gives a good functional and cosmetic results but is technically demanding, requires microsurgical skills and adequate facilities and is not always possible.When replantation is not possible, the use of a local advancement palmar flap preserves digital length and the remaining nail bed.

However, when the amputation is through the proximal third of the nail, this technique leaves very little nail bed and nail deformities are common.To avoid these deformities, complete ablation of the nail bed and germinal matrix with closure by a palmar advancement flap, or by shortening, are usually carried out. Unfortunately, these treatments often fail to satisfy the patient's desire to retain his or her nail.

When replantation is not feasible, the technique of advancing a palmar V-Y flap and applying the nail bed retrieved from the amputated part to the dorsum of the flap provides an alternative means of restoring nail bed length. So the technique of using composite bone and nail bed graft from the amputated part with a local or regional cutaneous flaps may be an option for treatment of fresh fingertip amputation to restore the shape and preserve the length of the fingertip especially in circumstances when microsurgical replantation is not feasible.

Conditions

Finger Tip Amputations

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Patients with Finger Tip Amputations

Patients with Finger Tip Amputations

Group Type: EXPERIMENTAL

The Use of Composite Bone and Nail Bed Graft Combined With Cutaneous Flaps for Reconstruction of Finger Tip Amputations

Intervention Type: PROCEDURE

1. The amputated finger tip is cleaned and a composite graft including the nail bed and bone of distal phalanx is taken from the amputated part.

2. The bone of the amputated part is fixed to the remaining stump of the distal phalanx with an axial 21gauge needle or by a K-wire (0.8 mm).

3. The nail bed graft is sutured with 6-0 vicryl to the remaining nail bed.

4. A local or regional cutaneous flap is used to cover the volar aspect and tip of the distal phalanx bone e.g. V-Y advancement flap, thenar flap or cross finger flap .The flap should protrude beyond the tip, providing extra skin which is recontoured to a rounded tip.

5. The nail plate is inserted in the nail fold to prevent the formation of synechiae between the nail fold and the injured nail bed.

6. The finger is immobilized for two weeks in a below elbow dorsal slab.

7. Patients are followed up for 3 months. Postoperative complications and their management will be recorded.

Interventions

The Use of Composite Bone and Nail Bed Graft Combined With Cutaneous Flaps for Reconstruction of Finger Tip Amputations

1. The amputated finger tip is cleaned and a composite graft including the nail bed and bone of distal phalanx is taken from the amputated part.

2. The bone of the amputated part is fixed to the remaining stump of the distal phalanx with an axial 21gauge needle or by a K-wire (0.8 mm).

3. The nail bed graft is sutured with 6-0 vicryl to the remaining nail bed.

4. A local or regional cutaneous flap is used to cover the volar aspect and tip of the distal phalanx bone e.g. V-Y advancement flap, thenar flap or cross finger flap .The flap should protrude beyond the tip, providing extra skin which is recontoured to a rounded tip.

5. The nail plate is inserted in the nail fold to prevent the formation of synechiae between the nail fold and the injured nail bed.

6. The finger is immobilized for two weeks in a below elbow dorsal slab.

7. Patients are followed up for 3 months. Postoperative complications and their management will be recorded.

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• Any level of finger tip amputations through the nail bed and distal phalanx with preserved amputated part.

Exclusion Criteria

• Crushed part of amputated segment.
• Patients with peripheral vascular disease.
• Diabetic patient.
• Pateint over 65 or under 5 years of age.
• Patient refusal.

• Minimum Eligible Age: 5 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Sohag University

OTHER

Sponsor Role: lead

Responsible Party

Hassan Abdellatif Hamed

Resident-plastic department-sohag hospital university

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Sohag university Hospital

Sohag, , Egypt

Site Status: RECRUITING

Countries

Egypt

Central Contacts

Hassan H Hamed, resident

Role: CONTACT

hassanhamed@med.sohag.edu.eg

01158742230

SaMIA Ahmed, professor

Role: CONTACT

Facility Contacts

Magdy M Amin, professor

Role: primary

References

Allen MJ. Conservative management of finger tip injuries in adults. Hand. 1980 Oct;12(3):257-65. doi: 10.1016/s0072-968x(80)80049-0.

Reference Type: BACKGROUND

PMID: 7002744 (View on PubMed)

Brown RE, Zook EG, Russell RC. Fingertip reconstruction with flaps and nail bed grafts. J Hand Surg Am. 1999 Mar;24(2):345-51. doi: 10.1053/jhsu.1999.0345.

Reference Type: BACKGROUND

PMID: 10194021 (View on PubMed)

Celik N, Wei FC, Lin CH, Cheng MH, Chen HC, Jeng SF, Kuo YR. Technique and strategy in anterolateral thigh perforator flap surgery, based on an analysis of 15 complete and partial failures in 439 cases. Plast Reconstr Surg. 2002 Jun;109(7):2211-6; discussion 2217-8. doi: 10.1097/00006534-200206000-00005.

Reference Type: BACKGROUND

PMID: 12045538 (View on PubMed)

Cheung K, Hatchell A, Thoma A. Approach to traumatic hand injuries for primary care physicians. Can Fam Physician. 2013 Jun;59(6):614-8.

Reference Type: BACKGROUND

PMID: 23766041 (View on PubMed)

Other Identifiers

Soh-Med-23-07-02MS

Identifier Type: -

Identifier Source: org_study_id