A new technique in fingertip defects including nail lost reverse dorsal fascial flap with skin graft

Background/Aim: Many different flaps described in the reconstruction of fingertip amputations may not provide optimal esthetic appearance due to hyponychial tissue loss and the lack of volar support of the nail bed. Except for free nail transfer and composite graft, the number of techniques described for nail reconstruction of the finger is limited. We aimed to investigate the utility of the reverse dorsal facial flap and to determine satisfaction rate of the esthetic and functional results obtained. Patients and Methods: Sixteen patients who were referred due to fingertip amputation including loss of nail bed between 2014 and 2017 and who could not be replanted were prospectively included. Flap planning was made from the proximal part of the nail bed toward the middle phalanx depending on the defect size. The skin was harvested superficially to the lateral side and kept on the fascial layer at the bottom. A fascial flap was harvested by preserving the paratenon. The flap was transposed, and the reconstructed area of the nail bed or defect of the nail bed was closed. A full‑thickness skin graft was applied over the fascia.

Results: There was no total flap loss or partial necrosis in any patient. None of the patients had complications that would require a second flap surgery. The mean Visual Analog Scale score of the patients control was 1.06. The calculated Disabilities of Arm, Shoulder, Hand score was 3.08. The mean Likert score of the patients was 17.

Conclusion: The dorsal fascial flap can be applied as an alternative surgical method in patients with fingertip defects including nail loss or damage in order to provide esthetically favorable nail appearance.