The Application Of Nail Removal In Distal Phalanx Replantation

Objectives1. To determine the effect in success rate of the removed the nail from the nail bed to prevent venous insufficiency in a non-anastomosed vein.MethodsNinety (90) patients and altogether Hundred-and-eight (108) amputated fingers of the distal phalanges were replanted at our hospital from the period of September 2008 to September 2010. In which there were forty-six (46)patients and fifty (50) fingers with anastomosed veins, and forty-four (44) and fifty-eight (58) fingers with non-anastomosed veins. The case records and available radiographs of these patients were studied. The outpatient records of the patients who followed up at this hospital were reviewed and those patients who followed up at other distant institutions were interviewed via telephone.Their pre-operative, intra-operative, immediate post-operative and follow up status were studied and documented. The success rates of the two are compared.And the success rate of the non-anastomosed finger with removed nails are also compared to the non-anastomosed group to determine the effect of success rate in the non-anastomosed groupResultsPatients spent an average of 10 days (range 2 to 22 days) in total in hospital.Out of 46 patients (50 fingers) of the anastomosed group, 32 patients (32 fingers) are successfully replanted, and 14 patients (18 fingers) are unsuccessful(success rate: 64.0%). And out of 44 patients (58 fingers) of the non-anastomosed group, 20 patients (20 fingers) were successfully replanted,while the rest 24 patients (38 fingers) were all unsuccessful (success rate:34.5%).Out of 44 patients (58 fingers) of the non-anastomosed group, 24 patients(30 fingers) had their nail removed from their nail bed. And out of the 30 removed nail fingers, only 10 fingers developed necrosis and finally amputated(success rate: 66.7%)ConclusionDigital replantations of the distal phalanges are in some cases can be complicated due to lack of branches of arteries and vein in the distal part of the finger. The amputated finger have better survival rate when it has sufficient blood circulation and with venous insufficiency being the one of the most common complication in digital replantation, it is recommended to anastomosed all the vein that are able to be anastomosed as it has a significant impact on the success rate of the anastomosed vein and the non-anastomosed vein of the digital replantation surgery.In cases of non-anastomoseable vein, removing of the amputated nail from the nail bed has been proved to have a significant effect on the success rate of the amputated digits.