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J Hand Surg Eur Vol. 2014 Jun;39(5):499-504. doi: 10.1177/1753193413489794. Epub 2013 May 29.

Primary functional and aesthetic restoration of the fingernail in distal fingertip amputations with the eponychial flap.

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


Fingertip injuries often result in fingernail defects. Reconstruction of this structure is important for adequate functional and aesthetic results. This study evaluates the eponychial flap reconstruction technique in 45 fingertip amputations with loss of more than half the fingernail. In 33 cases the procedure was performed in combination with a palmar island flap for pulp reconstruction. Average follow up was 5 months. All eponychial flaps healed uneventfully. In 44 cases, the pulp volume was restored without nail growth disturbance. Five complications (9%) were observed (pain, soft nail, and nail deformity). Only one hook nail deformity required reoperation. All patients were satisfied with the aesthetic and functional outcome. We found eponychial flap fingernail reconstruction effective even for injuries proximal to the lunula and have extended the indication for this technique to very proximal fingernail defects. Eponychial flap reconstruction is a simple, safe, and time-effective technique without donor site morbidity. Simultaneous reconstruction of dorsal and palmar injuries should both be performed primarily resulting in the restoration of a satisfying fingertip.


Eponychial plasty; fingertip injuries; nail complex

[Indexed for MEDLINE]

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