Reconstruction of the Great Toe Ski-Slope, Sunken-Nail Deformity with a Buried Adipofascial Flap

2004 ◽  
Vol 94 (6) ◽  
pp. 578-582
Author(s):  
Thomas S. Roukis ◽  
Adam S. Landsman
Keyword(s):  
Nail Plate ◽  
Surgical Excision ◽  
Distal Phalanx ◽  
Great Toe ◽  
Nail Bed ◽  
Adipofascial Flap ◽  
Nail Deformity ◽  
Complete Surgical Excision ◽  
Surgical Options ◽  
Normal Architecture

Development of a ski-slope deformity following loss of the great toe nail plate is a problematic condition with few conservative or surgical options available. The condition becomes more difficult to treat when the distal, medial, and lateral labial nail folds are hypertrophied, creating the appearance of a sunken nail. We present a case of ski-slope, sunken-nail deformity following multiple attempts at chemical nail matrixectomy. The patient’s persistent pain and deformity were managed through 1) nail plate avulsion and complete surgical excision of the germinal nail matrix, 2) remodeling of the distal phalanx, and 3) elevation of an adipofascial flap from the plantar tuft of the great toe, which was brought from plantar to dorsal and interposed between the dorsal aspect of the distal phalanx and the overlying nail bed in buried fashion. The combination of these procedures elevated the nail bed, which restored normal architecture to the great toe and relieved the pain associated with the chronic deformity. This case demonstrates a potential complication of a commonly performed procedure and a salvage technique useful for dealing with the resultant ski-slope, sunken-nail deformity (J Am Podiatr Med Assoc 94(6): 578–582, 2004)

A MODIFIED PERIUNGUAL APPROACH FOR TREATMENT OF SUBUNGUAL GLOMUS TUMOUR

Hand Surgery ◽  
2007 ◽  
Vol 12 (03) ◽  
pp. 217-221 ◽  
Author(s):  
S. T. Fong ◽  
Y. L. Lam ◽  
Y. C. So
Keyword(s):  
Surgical Excision ◽  
Glomus Tumour ◽  
Complete Excision ◽  
Nail Bed ◽  
Peripheral Lesion ◽  
Nail Deformity ◽  
Complete Surgical Excision ◽  
Central Lesions

Subungal glomus tumours are uncommon; the only treatment is complete surgical excision. Transungual approach is often preferred; however, secondary nail deformity may occur. Lateral periungual approach is used to avoid this complication, but this approach provides limited exposure and is used for peripheral lesion only. We describe a modified periungual approach which can be applied to central lesions. This approach can provide adequate exposure for complete excision of the subungual tumour while avoiding incision of the nail bed.

scholarly journals Subungual Glomus Tumor: A Review of 15 Cases Treated with Partial Nail Plate Excision Technique

2021 ◽  
Author(s):  
Mahmoud Farzan ◽  
Mahdi Neshan ◽  
Amir Reza Farhoud ◽  
Abbas Abdoli
Keyword(s):  
Glomus Tumor ◽  
Nail Plate ◽  
Tumor Location ◽  
Tumor Treatment ◽  
Nail Bed ◽  
Nail Deformity ◽  
Surgical Methods ◽  
The Matrix ◽  
The Mean

Background: Although there are various surgical methods for subungual glomus tumor treatment, there is no consensus on the optimal surgical approach. Methods: We analyzed the outcomes of 15 patients treated with partial nail plate excision technique. The medial or lateral section of the nail plate was excised longitudinally based on the tumor location. After incision of the nail bed and tumor removal, the matrix was repaired carefully. Results: In this study, 15 people, including 11 men and four women, were studied. The mean onset of symptoms until diagnosis was 88 months. In the postoperative evaluation, the mean follow-up was 20 months. Two patients had recurrent tumors, and one had postoperative nail deformity. Conclusion: Meticulous nail bed repair and complete tumor excision are key treatment points needed to prevent nail deformity and recurrence.  

Use of Modified Tension Band Sutures for Fingernail Disruptions

2007 ◽  
Vol 32 (6) ◽  
pp. 668-674 ◽  
Author(s):  
H. S. PATANKAR
Keyword(s):  
Nail Plate ◽  
Distal Phalanx ◽  
Tension Band ◽  
Age Group ◽  
Simple Method ◽  
Nail Bed ◽  
Finger Nail ◽  
Wire Fixation ◽  
Displaced Fracture

A series of 66 patients, aged between 1 and 70 years, with 70 disruptive injuries to finger nails was reviewed. The injuries were treated by cleaning of the finger, evacuation of haematoma and anatomical replacement of the nail plate, or a substitute, which was secured with a modified dorsal tension band suture without formal repair of the nail bed. K-wire fixation of the distal phalanx was employed only in the event of displaced fracture of the distal phalanx, complete absence of the nail plate and laceration extending to the distal pulp. This simple method, which bypasses the injured and friable, but vital nail structures resulted in uncomplicated reformation of the normal nail plate in all of the cases. Removal of the nail plate and formal repair of the nail bed is not necessary in any age group with finger nail disruptions.

scholarly journals A Bony Mallet Thumb with Interposition of the Nail Plate

2021 ◽  
Vol 07 (01) ◽  
pp. e18-e21
Author(s):  
Ahmadreza Afshar ◽  
Ali Tabrizi ◽  
Hassan Taleb
Keyword(s):  
Surgical Treatment ◽  
Nail Plate ◽  
Distal Phalanx ◽  
Clinical Suspicion ◽  
Flexion Deformity ◽  
Articular Fracture ◽  
Left Thumb ◽  
Nail Deformity ◽  
Bony Avulsion ◽  
Joint Incongruity

AbstractThumb extensor injuries and bony avulsion in the distal phalanx of the thumb are rare compared with other fingers. The most reported complications are infection, nail deformity, joint incongruity, implant failure, recurrent flexion deformity, and residual pain. This report presents a case of 30-year-old man suffering from an injury in the left thumb distal phalanx with a displaced comminuted intra-articular fracture of the distal phalanx of the left thumb. The nail plate was interposed between the dorsal and palmar fragments. The interposition of the nail plate in the bony mallet thumb has not been described before. Surgical treatment and fixation with a 2-mm miniscrew resulted in successful treatment. Clinical suspicion of this complication is of great importance and can affect treatment outcomes.

Graft Reposition on Flap: Mid-Term Result in Allen Type IV Amputation

2019 ◽  
Vol 24 (02) ◽  
pp. 219-223 ◽  
Author(s):  
Vijay A. Malshikare
Keyword(s):  
Learning Curve ◽  
Local Flaps ◽  
Term Result ◽  
Nail Bed ◽  
Type Iv ◽  
Nail Deformity ◽  
Surgical Units ◽  
Surgical Options ◽  
Finger Tip

Background: The preferable reconstructive surgical options for Allen type IV finger amputation is replantation. The viable alternate option is bone and nail bed graft repositioning on local flaps. The wider scope of this “graft reposition on flap” (GRF) technique was introspected.Methods: Fifteen patients who sustained type IV amputations of finger tip were operated between 2013 and 2017 by GRF technique. The results, range of motions, functional out come and its feasibility were analyzed and evaluated. A technical modification of GRF was also described within this series of patients.Results: All patients had good nail bed survival and well settled local flaps. Static two-point discrimination (2PD) was of 6.4 mm (average). 14/15 patients had an acceptable shortening of 4mm (average). Overall patients were happy after surgery and returned back to their work. All had excellent range of movements and 0 VAS. The follow up was 1 to 5 years (mean 2.8 years). Wound infection was seen in one patient whom after debridement developed gross shortening and thick nail. None developed nail deformity.Conclusions: The GRF provided an alternative option for Allen type IV amputations of finger tip. It can be well executed in all reconstructive surgical units and in those with a learning curve for replantations surgeries. The results of GRF were proportionate with the available surgical options in terms of appearance, function and outcomes.

DISTAL PHALANGEAL RECONSTRUCTION FOR RECURRENT INTRAOSSEOUS EPIDERMOID CYST OF THE FINGER — A CASE REPORT

Hand Surgery ◽  
2011 ◽  
Vol 16 (03) ◽  
pp. 375-377 ◽  
Author(s):  
Kazuya Kurosawa ◽  
Ryoichi Kobayashi ◽  
Kenji Takagishi
Keyword(s):  
Case Report ◽  
Epidermoid Cyst ◽  
Nail Plate ◽  
Ring Finger ◽  
Distal Phalanx ◽  
Nail Bed ◽  
Distal Half ◽  
Longitudinal Incision ◽  
Bone Fusion ◽  
And Function

Intraosseous epidermoid cyst of the finger phalanx is rare. We report a case of postoperative recurrent intraosseous epidermoid cyst of the distal phalanx of the ring finger. To prevent further recurrence while maintaining morphology and function, the distal half of the distal phalanx that included the epidermoid cyst was resected to completely remove the lesion. The distal phalanx was then reconstructed by grafting corticocancellous bone from the ilium and shaped into a distal phalanx. The operation was performed using a through-the-nail approach, temporarily removing the nail and placing a longitudinal incision in the nail bed to approach the phalanx. Postoperatively, bone fusion was achieved without recurrence and the shape of the distal phalanx was normal. Distal phalangeal hypertrophy and nail plate deformity also normalized and excellent results were obtained.

scholarly journals A Step-By-Step Approach of the In Situ Thin Split-Thickness Toe-Nail Bed-Graft for the Treatment of Subungual Exostosis

2020 ◽  
pp. 1-4
Author(s):  
Panagiotis G. Tsailas ◽  
Chrysoula Argyrou ◽  
Panagiotis G. Tsailas
Keyword(s):  
Quality Of Life ◽  
Young Adults ◽  
Current Literature ◽  
Negative Impact ◽  
Distal Phalanx ◽  
Nail Bed ◽  
Nail Deformity ◽  
In Situ Split

Subungual exostosis (SE) is a rather uncommon benign bony outgrowth of the distal phalanx of the toes, affecting mainly adolescents and young adults. While inherently painless, it grows progressively and leads to nail deformity which eventually produces pain and has negative impact on the quality of life of the affected individual. The present paper presents a step-by-step guide to the in situ split-thickness toenail bed graft technique. The outcome of our case was in line with the current literature, the preservation of the nail led to a highly satisfactory cosmetic result, while no recurrence of the lesion was reported.

scholarly journals Subungual glomus tumour excision: The nail plate flap technique

2017 ◽  
Vol 2 (3) ◽  
Author(s):  
Sandeep Mehrotra ◽  
Vikas Singh ◽  
Uday Singh Dadwal
Keyword(s):  
Nail Plate ◽  
Glomus Tumour ◽  
Nail Bed ◽  
Beneficial Effects ◽  
Flap Technique ◽  
Accurate Localization ◽  
Nail Deformity ◽  
Improved Outcomes ◽  
One Year

<p>Subungual glomus tumours, though rare, cause distressing symptoms and merit surgical treatment with minimal morbidity. Approaches to the nail bed over the years have varied from earlier nail excisions to trans/sub/periungal techniques. Nail plate preservation has beneficial effects on pain, and cosmesis and surgical modifications to ensure the same are desirable. We employed a simple nail preservation technique on six patients over the last seven years. After an accurate localization of the lesion based on pin test and MRI, a proximally-based nail plate flap was marked and elevated beyond the glomus. The tumour was removed through a linear nail-bed incision, following which the nail plate flap was reposited without suturing. All cases had gratifying relief of symptoms. Within a few weeks of the excision, no nail distortion was noticeable. No recurrences were noted on follow-up for one year. The nail flap transungal approach relies on accurate preoperative tumour localization. It ensures a protective post-operative cover with reduced pain. A minimalistic approach with no skin incisions ensures less morbidity and improved cosmesis with no nail deformity. The nail plate flap technique can be employed in selected cases for improved outcomes.</p>

A Zigzag Flap for Correcting a Nail Deformity Caused by Subungual Schwannoma

2021 ◽  
Vol 111 (4) ◽  
Author(s):  
AnLi Lee ◽  
Chi-Yuan Tzen ◽  
Chia-Meng Yu ◽  
Ming-Feng Tsai
Keyword(s):  
Nail Plate ◽  
Tumor Excision ◽  
Nail Bed ◽  
Nail Deformity ◽  
Complete Tumor

Subungual schwannoma is quite rare and often causes nail deformity and difficulty in wearing shoes. Complete tumor excision is the treatment of choice, and we advocate that restoring the nail appearance should be considered at the same time. We present the case of 43-year-old man with a big toe subungual schwannoma. We designed a zigzag incision method to excise the tumor and also corrected nail-bed deformity. The patient had a smooth recovery, and the nail plate regrew with a good appearance.

Osteomyelitis of the distal phalanx following trauma to the nail. A case report

1992 ◽  
Vol 82 (10) ◽  
pp. 542-544 ◽  
Author(s):  
IM Fox
Keyword(s):  
Case Report ◽  
Chronic Osteomyelitis ◽  
Nail Plate ◽  
Distal Phalanx ◽  
Nail Bed ◽  
Phalangeal Fracture

A case in which inadequate treatment of a nail plate injury resulted in chronic osteomyelitis has been described. Because of its distinct anatomy, trauma to the nail and its associated structures should not be summarily dismissed as an innocuous injury but should be thoroughly examined for phalangeal fracture and laceration of the nail bed.

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