Objective To investigate the effectiveness of dorsal metacarpal island flap for treating scar contracture of the finger web. Methods Between June 2009 and December 2010, 10 patients with scar contracture of the finger web were treated. There were 6 males and 4 females with an average age of 30 years (range, 14-57 years). Scar contracture was caused byinjury in 8 cases, by burn in 1 case, and by operation in 1 case. The locations were the 1st web space in 1 case, the 2nd web space in 3 cases, the 3rd web space in 5 cases, and the 4th web space in 1 case. The disease duration was 3 to 9 months with an average of 5 months. The maximum abduction was 10-20°. After web space scar release, the dorsal metacarpal island flap (3.5 cm × 1.2 cm-4.0 cm × 2.0 cm in size) was used to reconstruct web space (2.0 cm × 1.0 cm-3.0 cm × 1.8 cm in size). The donor site was directly sutured or repaired with local flaps. Results At 2 days after operation, necrosis occurred in 1 flap, which healed by extractive treatment. The other flaps survived and wound healed by first intention; all the flaps at donor sites survived and incision healed by first intention. Ten patients were followed up 6 to 15 months (mean, 9 months). The reconstructed web space had good appearance, the maximum abduction was 80 ° in 1 case of the 1st web space scars contracture, and the maximum abduction was 35-45° (mean, 40°) in the other 9 cases. In 8 scar patients causing by injury, no scar contracture recurred during follow-up. Conclusion It can achieve good results in appearance and function to use dorsal metacarpal island flap for treating scar contracture of the finger web.
Objective To investigate the effectiveness of split nail in the emergency treatment of nail bed partial defect. Methods Between February 2008 and August 2011, 27 cases (30 fingers) of nail bed partial defect were treated. There were 19 males (22 fingers) and 8 females (8 fingers) with an average age of 27.4 years (range, 16-64 years). The causes of injury included machine injury in 25 cases and cutting injury in 2 cases. The injured fingers included 5 thumbs, 7 index fingers, 11 middle fingers, and 9 ring fingers. The disease duration ranged from 30 minutes to 7 hours with an average of 4.3 hours. The size of nail bed defect ranged from 4 mm × 3 mm to 9 mm × 5 mm. All defects were repaired with residual split nail (4 mm × 3 mm-10 mm × 6 mm in size). Results The split nail survived in 25 cases (28 fingers), and primary healing of wound was obtained. Exudation occurred in 2 cases (2 fingers) and was cured after symptomatic treatment. Twenty-three patients (25 fingers) were followed up 5-17 months (mean, 11.1 months). At 3-5 months after operation, the fingernail regeneration was observed in all fingers. Except 2 cases (2 fingers) of delayed healing having poor nail growth, the other patients had smooth nail and normal finger tip function without pain. According effectiveness standard for fingernail regeneration, the results were excellent in 15 fingers, good in 6 fingers, fair in 3 fingers, and poor in 1 finger, with an excellent and good rate of 84%. Conclusion It is a simple and effective method to use residual split nail for emergency treatment of nail bed partial defect.