The Use of Composite Bone and Nail Bed Graft Combined with Cutaneous Flaps for Reconstruction of Fingertip Amputations

Background: The technique of using composite bone and nail bed graft from the amputated part with a local cutaneous flap may be an option for treatment of fresh fingertip amputation to restore the shape and preserve the length of the fingertip. The aim of this work was to evaluate the outcome of the use of composite bone and nail bed graft combined with different local cutaneous flaps for reconstruction of fingertip amputations.Methods: This prospective clinical study was carried out on 17 patients aged from 5 to 65 years old, both sexes, with any level of fingertip amputations through the nail bed and distal phalanx with preserved amputated part. Results: Flap used was cross finger in 16 (94.12%) patients and V-Y flap in 1 (5.88%) patient. Flap viability was viable in 13 (81.25%) patients, partial loss in 2 (12.5%) patients and lost in 1 (6.25%) patient. Nail bed survival was viable in 6 (37.5%) patients, partial loss in 5 (31.25%) patients and lost in 5 (31.25%) patients. Bone graft survival was viable in 12 (75%) patients, partial loss in 2 (12.5%) patients and lost in 2 (12.5%) patients. Bone union was united in 12 (85.71%) patients and ununited in 2 (14.29%) patients. Conclusions: Composite bone and nail bed grafts combined with local and regional cutaneous flaps can effectively reconstruct fingertip amputations, particularly in patients where replantation is not feasible. Despite most favorable outcomes regarding flap viability and bone union, there were notable instances of nail bed loss.