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Hand Clin 2021 Feb;37(1):67-76

Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge Street #3, Springfield, IL 62702, USA.

This article reviews the nomenclature, anatomic components, and physiologic growth involving the perionychium. Fingertip and nailbed injuries are commonly encountered problems in hand surgery. This article focuses primarily on dealing with chronic nailbed deformities following traumatic injury such as nonadherence, split nails, avulsion loss, and hook nails. Read More

Ther Umsch 2020 Jun;77(5):199-206

Universitätsklinik für Plastische- und Handchirurgie, Inselspital Bern.

Treatment of acute injuries of the hand Injuries to the hand are a common presentation in primary care units. When accurately assessed, many open injuries may be handled in the emergency department without referral to a hand surgery specialist. We would like to give some recommendations on how to treat the most frequent injuries like lesions to the nail and nailbed, fingertip amputation as well as burns, infections and bites. Read More

Eur J Trauma Emerg Surg 2020 Aug 10. Epub 2020 Aug 10.

Department of Orthopedics, Hand and Reconstructive Microsurgery, Olympia Hospital and Research Centre, 47, 47A Puthur High Road, Puthur, Trichy, Tamilnadu, 620017, India.

Purpose And Background: Replantation of the distal fingertip amputation poses a technical challenge to the treating hand surgeon especially dealing with motorcycle spokes wheel injury causing Allen's type III and IV amputation. The reason being the pulp charred and severely crushed. Various reconstructive options have been described in the literature. Read More

J Hand Surg Asian Pac Vol 2020 Jun;25(2):199-205

Hand and Reconstructive Microsurgery Service, Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore.

Fingertip amputation injuries are common hand injuries amongst all ages. If occurring as a result of workplace accidents, these injuries has the potential to lead to significant socioeconomic costs. Non-surgical techniques can treat these injuries with the potential to alleviate the burden of these socioeconomic costs. Read More

Semergen 2020 Mar 2;46(2):140-144. Epub 2019 Aug 2.

Servicio de Radiodiagnóstico, Hospital Universitario de Burgos (HUBU), Burgos, Castilla y León, España.

The nail plate is a layer of keratin that protects the back of the ends of the fingers and toes. It is a system with many important functions, since it stabilises the distal portion of the finger and toe and provides resistance to the fleshy part, thus contributing to the handling of small objects and fine sense of touch. Nail injuries are a reason for visits to Emergency Departments and Primary Care, representing up to 8% of hand emergencies. Read More

Indian J Orthop 2017 Nov-Dec;51(6):709-713

Department of Physiology, Sree Narayana Institute of Medical Sciences, Ernakulum, Kerala, India.

Background: Management of nail injuries can often be a challenging experience, especially in presence of complex fingertips' injuries that include soft tissue loss and distal phalanx injury. Most studies found in the literature focus on individual injuries and describe methods to tackle those injuries, notwithstanding the fact that the nail, nailbed, distal phalanx, soft tissue and skin of the finger tip form a complex and often more than one element of this complex is injured. This retrospective study therefore focuses on the management of nail bed injuries as a part of the complex finger tip injury and outlines the surgical principles and techniques that were used in their management. Read More

Am J Emerg Med 2017 Jul 6;35(7):1035.e1-1035.e3. Epub 2017 Feb 6.

Kansas University Medical Center, Department of Orthopedic Surgery, Kansas City, KS, United States.

Open physeal fractures of the distal phalanx of the hallux are the lesser described counterpart to the same fracture of the finger, known by its eponym as a "Seymour fracture". Displaced Salter-Harris phalangeal fractures present with a concomitant nailbed or soft tissue injury. Often these fractures occur in the summer months when open-toe footwear can be worn, however, they may occur indoors as well. Read More

Clin Pediatr (Phila) 2018 Jan 22;57(1):31-35. Epub 2017 Jan 22.

1 Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Hoverboards were recently introduced to the US consumer market and experienced rapid popularity. Given the high frequency of musculoskeletal injury with other wheeled recreation devices, we sought to analyze hoverboard injuries in children. A retrospective review of patients with musculoskeletal injury related to hoverboard use was performed at a tertiary care children's hospital. Read More

Microsurgery 2016 Nov 9;36(8):628-636. Epub 2016 Apr 9.

Hand and Microsurgery Department, Medicalpark Gebze Hospital, Istanbul Bilgi University, Medicalpark Gebze Hospital Kavak Cad. No.3 Gebze-Kocaeli, Turkey.

Introduction: Distal finger replantations are technically difficult operations due to small vessel sizes and narrow field of vision. The results of 25 distal finger replantations performed by dorsal approach are presented. The technical benefits and details of this technique is discussed with a literature review. Read More

J Hand Surg Am 2016 Jan;41(1):122-8

Division of Hand Surgery, Department of Surgery, Christine M. Kleinert Institute for Hand and Microsurgery, Kleinert Kutz Hand Care Center, University of Louisville, Louisville, KY. Electronic address:

The reverse cross finger flap is usually performed on patients with deep dorsal digital skin, nailbed, and extensor tendon injuries that cannot be repaired and grafted. These patients will require additional dorsal digital flaps from the adjacent fingers. Read More

J Pediatr Orthop 2017 Jun;37(4):247-253

*Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center †Children's Medical Center of Dallas ‡Texas Scottish Rite Hospital for Children, Dallas, TX.

Background: To describe treatment methods and complication rates of all open Seymour fractures (Salter-Harris I/II or juxta-epiphyseal fractures of the distal phalanx of the hand with associated nailbed laceration) treated at or referred to a pediatric level 1 trauma center over a 10-year time period. We hypothesized that delayed treatment of Seymour fractures results in higher infectious complication rates.

Methods: We identified all patients treated for open Seymour fractures at the orthopaedic hand clinic at our level 1 pediatric trauma center between August 2002 and December 2012. Read More

Tech Hand Up Extrem Surg 2015 Sep;19(3):115-9

Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.

Reconstruction of the distal phalanx bone in cases with painful nonunion is a rare and challenging problem. To restore anatomy and to provide a good cover for the bone graft, an intact nailbed is often required due to the proximity of these 2 structures. We present 3 cases of distal phalanx reconstruction performed with a free corticocancellous bone graft from the distal radius and nailbed reconstruction with a homodigital dorsal reverse adipofascial flap based on an exteriorized pedicle that avoids the dissection of the germinal matrix of the nail. Read More

Hong Kong Med J 2015 Jun 8;21(3):237-42. Epub 2015 May 8.

Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.

Objectives: To determine the mechanism and epidemiology of paediatric finger injuries in Hong Kong during 2003-2005 and 2010-2012.

Design: Comparison of two case series.

Setting: University-affiliated teaching hospital, Hong Kong. Read More

J Hand Surg Am 2015 Jul 4;40(7):1382-8. Epub 2015 May 4.

Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, FL. Electronic address:

Purpose: To report our experience with the use of a digital artery perforator propeller flap based on a constant distal perforator in the middle phalanx for resurfacing of lateral oblique fingertip amputations.

Methods: Twelve fingertips in 10 patients underwent reconstruction, with a mean follow-up of 8 months (range, 8-12 mo). The size of the flaps ranged from 2. Read More

Unfallchirurg 2015 Feb;118(2):155-66; quiz 167-9

Abteilung für Unfall-, Hand- und Wiederherstellungschirurgie, Chirurgische Universitätsklinik, Universitätsmedizin Rostock, Schillingallee 35, 18055, Rostock, Deutschland,

The treatment of acute peripheral finger injuries is part of the daily routine of surgeons in emergency departments. This article presents the most common forms of peripheral finger injuries and the specific diagnostic and therapeutic aspects. The injuries include incision and tear injuries, injuries to the nailbed, distal extensor tendon injuries, severed flexor tendons of the distal joint, bite injuries, high-pressure injection injuries and amputation injuries of the distal phalanx of fingers. Read More

J Hand Surg Am 2013 Nov;38(11):2173-9

Department of Orthopaedic Surgery, Anadolu Medical Center, Kocaeli, Turkey; Department of Orthopaedic Surgery, Academic Hospital, Istanbul, Turkey. Electronic address:

Purpose: We report our experience, treatment protocol, and 2-year follow-up results of 24 fingertip replantations treated using the artery-only technique without vein or nerve repair.

Methods: We performed a retrospective review of 24 patients who had undergone fingertip replantation at the same center between 2005 and 2011. All patients in this study had complete fingertip amputation at or distal to the distal interphalangeal joint of the fingers or interphalangeal joint of the thumb. Read More

J Hand Surg Am 2013 Dec 1;38(12):2360-4. Epub 2013 Nov 1.

Department of Orthopaedic Surgery, School of Medicine, Keio University; and the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan. Electronic address:

Purpose: To assess the outcomes of our technique involving oblique headless compression screw for arthrodesis of the thumb interphalangeal joint and the distal interphalangeal joints of the other digits.

Methods: A total of 28 joints (19 thumb interphalangeal and 9 distal interphalangeal) in 23 patients with a mean age of 65 years (range, 58-74 y) were retrospectively analyzed. All operations were performed with the Acutrak2 micro-screw. Read More

Hand Surg 2013 ;18(2):297-9

Hand and Microsurgery Section, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore.

Radial or ulnar oblique amputations treated by nailbed levelling and local digital flap reconstruction can result in significantly shortened fingertip, narrowed pulp and nail shape distortion. A VY type flap containing bone, sterile matrix, and skin was conceptualised to restore nail and pulp contour for coronal oblique amputations. Technical details and a clinical case are discussed. Read More

J Hand Surg Am 2013 Jul 23;38(7):1307-14. Epub 2013 May 23.

Department of Plastic and Reconstructive Surgery, Bundang CHA Medical Center, CHA University, Seongnam, Korea.

Purpose: To report our technique and results with treating fingertip amputations with flaps and simultaneous nailbed grafts.

Methods: We reconstructed 20 fingertip amputations with loss of bone and nail with flaps combined with nailbed grafts. We reconstructed the volar side of the fingertip with a flap, and the dorsal side of the fingertip with a nailbed grafted to the raw inner surface of the flap. Read More

J Plast Reconstr Aesthet Surg 2013 Jul 6;66(7):973-7. Epub 2013 Apr 6.

Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.

Purpose: This article aims to present a technique for thumb tip amputations using a homodigital soft-tissue/periosteum flap and a portion of the amputated digit.

Methods: Eight patients (aged 21-53 years) with avulsion thumb tip amputations were reviewed. We report a new technique in which a bone and nailbed composite graft was taken from the amputated portion of the thumb and a dorsoulnar flap combined with periosteum was harvested from the first metacarpal and designed to cover the volar bone. Read More

Curr Rev Musculoskelet Med 2013 Mar;6(1):18-25

Department of Orthopaedic Surgery, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA,

In the last 40 years, childhood hand and wrist injuries have become progressively more common as children have become heavier and more active in high impact sports. The majority of children with such injuries do well, but treatment is not always straightforward. Distal radius fractures, scaphoid fractures, metacarpal and phalangeal fractures, nailbed injuries, and amputations are among the pediatric hand and wrist injuries most often seen by orthopedists. Read More

Plast Reconstr Surg 2012 Feb;129(2):394e-396e

Paediatric Plastic Surgery Unit, St George's Hospital, London, United Kingdom.

J Hand Surg Am 2011 Jun 22;36(6):986-93. Epub 2011 Apr 22.

Department of Plastic, and the Department of Anesthesiology, Pain Treatment Centre, Erasmus MC, Rotterdam, The Netherlands.

Purpose: Peripheral nerve injury of the upper extremity frequently causes changes in the thermoregulatory system of the hands and fingers and leads to reports of cold intolerance. In this study, we aimed to measure the influence of median or ulnar nerve injury on cold-induced vasodilatation (CIVD) during prolonged cooling at low temperatures.

Methods: We tested 12 patients with a median (n = 6) or ulnar (n = 6) injury 4 to 76 months after nerve repair. Read More

J Plast Reconstr Aesthet Surg 2011 Sep 16;64(9):1242-4. Epub 2011 Feb 16.

Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland.

Flexor digitorum profundus (FDP) zone I tendon avulsion injury is traditionally repaired with a pullout suture technique. More recently, bone anchor sutures have been used as a viable alternative and have largely replaced areas in hand surgery where pullout suture technique was once required. To date, there have been very few complications reported related to bone anchor suture use in FDP tendon reattachment to the bone. Read More

Ann R Coll Surg Engl 2010 Sep 28;92(6):483-5. Epub 2010 May 28.

Department of Plastic & Reconstructive Surgery, St George's Hospital, London, UK.

Introduction: We performed an audit to assess frequency of injury to the nail bed and outcomes after repair in a busy paediatric hand trauma clinic.

Subjects And Methods: This retrospective study examines 46 consecutive nail bed repairs over a 6-month period. All notes were reviewed for patient demographics, details of the injury including the operation and aftercare. Read More

Ann Plast Surg 2008 Feb;60(2):150-3

Department of Surgery, King Saud University, Riyadh, Saudi Arabia.

The "homodigital distally based" dorsal adipofascial flap has been used by various authors to cover small, complex, dorsal, digital defects. In 2004, Al-Qattan reported on 3 cases in which a "distally based" dorsal adipofascial flap was used in a "cross-digital" fashion. In the current report, we expand on the concept of cross-digital adipofascial flaps in which the flaps are based not only distally but also proximally or laterally located. Read More

Scand J Plast Reconstr Surg Hand Surg 2007 ;41(6):315-9

Department of Plastic and Reconstructive Surgery, Vakif Gureba Training and Research Hospital, Istanbul, Turkey.

Amputations of the fingertip are the most common injuries to the upper limbs, and they cause greatest socioeconomic losses. The first choice of the technique of repair should be the simplest and fastest, with rapid restoration of function and an acceptable aesthetic appearance, and should return the worker to his job rapidly to prevent economic loss. Volar V-Y advancement flaps should therefore be considered first, but unless the dorsal loss is greater than the volar, this first choice of flap cannot be used because of the inadequate donor area. Read More

Ann Plast Surg 2006 Mar;56(3):279-83

Department of Plastic and Reconstructive Surgery, Kocaeli University Faculty of Medicine, Turkey.

The main aim of the treatment of fingertip amputations with no indication of replantation was to establish the functional and esthetic construction. The critical point in the utilization of the bone and nail tissue as a graft for reconstruction was to choose a flap that is sufficiently vascular to nourish these grafts. We have performed homodigital artery flaps to cover the bone and nailbed grafts taken from the amputation to restore fingertip function with an acceptable result. Read More

Ann Plast Surg 2004 Oct;53(4):353-9

Department of Orthopedic Surgery, Akita Red Cross Hospital, Akita, Japan.

In fingertip amputations, conventional stump plasty provides an almost acceptable functional result. However, replanting fingertips can preserve the nail and minimize loss of function. We investigated the functional and cosmetic results of fingertip replantation at the terminal branch of the digital artery. Read More

Plast Reconstr Surg 2003 Jul;112(1):337-8