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A Case Report of Nail Bed Reconstruction with Digital Artery Perforator (DAP) Flap and Buccal Mucosal Graft  

Lee, Yong-Woo (Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University)
Kim, Youn-Hwan (Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University)
Kim, Jeong-Tae (Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University)
Publication Information
Archives of Plastic Surgery / v.38, no.1, 2011 , pp. 113-116 More about this Journal
Abstract
Purpose: Many fingertip injuries are associated with nail injury and it is hard to repair to original shape due to its unique characteristic. Mucosal graft is used for a defect of the nail bed injury. Hereby, we introduce a DAP flap and buccal mucosal graft, with which we could reduce the defect size of the injured fingertip and donor site morbidity at the same time, without any need for harvesting additional skin from other part of hand. Also, mucosal graft makes good cosmetic and functional outcome of nail. Methods: This method was performed in a 56-year-old man with fingertip injury on dorsal side of left thumb due to electrical saw. First, DAP flap was performed on the injured finger to reduce the size of the defect of fingertip and cover the bone exposure. Second, nail bed part of the DAP flap was de-epithelized and buccal mucosal graft was done from left side of intraoral cavity wall. Results: Flap and graft survived without any necrosis but some nail bed could not be covered with flap due to insufficient flap size. All wounds healed well and did not present any severe adversary symptoms. Conclusion: DAP flap with mucosal graft is an effective method that we can easily apply in reconstruction of fingertip injury. We suggest that the combination of the two procedures makes good functional and cosmetic outcome compared to the usual manner, especially in cases of nail bed injury without distal phalanx bone defect.
Keywords
Digital artery perforator flap; Fingertip injury; Nail bed injury; Buccal mucosal graft;
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Times Cited By KSCI : 1  (Citation Analysis)
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1 Brown RE, Zook EG, Russell RC: Fingertip reconstruction with flaps and nail bed grafts. J Hand Surg Am 24: 345, 1999   DOI   ScienceOn
2 Mitsunaga N, Mihara M, Koshima I, Gonda K, Takuya I, Kato H, Araki J, Yamamoto Y, Yuhei O, Todokoro T, Ishikawa S, Eri U, Mundinger GS: Digital artery perforator (DAP) flaps: modifications for fingertip and finger stump reconstruction. J Plast Reconstr Aesthet Surg xx: 1, 2009
3 Lee CH, Jeong JM, Kim JH, Lim ST, Yoo KH, Park RP, Kim MB: Nail lengthening using the eponychial flap. J Korean Orthop Assoc 44: 449, 2009   DOI   ScienceOn
4 Lemmon JA, Janis JE, Rohrich RJ: Soft-tissue injuries of the fingertip: methods of evaluation and treatment. an algorithmic approach. Plast Reconstr Surg 122: 105e, 2008   DOI   ScienceOn
5 Hatoko M, Tanaka A, Kuwahara M, Yurugi S, Niitsuma K, Iioka H, Zook EG: Hard palate mucosal grafts for defects of the nail bed. Ann Plast Surg 49: 424, 2002   DOI   ScienceOn
6 Elbeshbeshy BR, Rettig ME: Nail-bed repair and reconstruction. Tech Hand Up Extrem Surg 6: 50, 2002   DOI   ScienceOn
7 Oh SK, Lee YJ, Lee YK, Woo SH: Immediate full-thickness nail bed graft with various skin flaps for the acute nail bed defects of fingertip injuries. J Korean Soc Surg Hand 12: 151, 2007