9.0: Thursday, March 17, 2005

Use of Dermal Substitute For Nail Bed Grafting

Troy Callahan, MD, Thomas Davenport, and Roger Simpson.

Purpose: The treatment of finger nail bed avulsion injuries without the morbidity of harvesting nail bed grafts from other sites. To accomplish this we have made use of a dermal substitute to repair full thickness nail bed (FTNB) loss.

Materials and Methods: Five patients over a twelve month period were treated for FTNB loss of the sterile matrix. These defects ranged from 36mm2 to 100mm2. Digital nerve blocks were performed with 1% lidocaine and finger tourniquet applied. The remaining fingernail plate was removed, and nail bed wound edges were sharply debrided in preparation for grafting. Alloderm was then contoured to the area of loss. The graft was secured using 6-0 vicryl sutures. The nail plate was replaced over the graft. The finger was splinted and wrapped in a sterile bulky dressing.

Results: All patients had graft survival. Subsequent examinations revealed new regenerating nail plate in all patients. Follow up ranges from three to ten months. An initial repair has complete nail bed healing, nail plate regeneration and no noticeable irregularities. The remaining repairs are in various stages of nail plate regeneration.

Conclusions: FTNB injuries of the sterile matrix can be effectively repaired using Alloderm saving the patient from additional morbidity.