| Objective: To compared the long-term clinical efficacy of toenail flap and split-thickness toenail bed free transplantation in repairing defects of fingernails bed,which can provide certain reference for the surgical selection of reconstructing nails.Methods: The cases of fingernail bed defects from August 2015 to November 2017 were retrospectively collected and divided into two groups according to the surgical procedure:(1)free toenail flap transplanted to repair the fingernail bed defect group(TF group);(2)free split-thickness toenail bed transplanted to repair the fingernail bed defect group(STTB group).TF group: 30 cases of 30 fingers(There were 4 cases of left thumb,8 cases of right thumb,5 cases of left index finger,9 cases of right index finger,2 cases of left middle finger and 2 cases of right middle finger);age from 18 to 49 years old;defect area from6mm×9mm to 13mm×18mm;patients consisted of 16 males and 14 females,the donor area was repaired with lateral calf free flap;STTB group: 30 cases of 30 fingers(There were 5 cases of left thumb,7 cases of right thumb,4 cases of left index finger,8 cases of right index finger,4 cases of left middle finger and 2 cases of right middle finger);age from 19 to 48 years old;defect area from 7mm × 10 mm to 14 mm × 17mm;patients consisted of 17 males and 13 females,the donor area was treated with oiled gauze covering and dressing wrapping.Both groups of patients had the same preoperative treatment,with timely surgical debridement,complete preoperative examinations,emergency surgery after signing the surgical consent form.The TF group received antispasmodic therapy,infection and thrombosis prevention.STTB group received symptomatic treatment for infection prevention.The total hospitalization expenses were calculated at discharge.Long-term follow-up was performed in both groups(postoperative 3 months,6 months,9 months,12months),to evaluate the clinical efficacy of reconstruction fingernail appearance and function in the 12 th month after surgery.The results which were used to analyze whether there were statistically significant differences between the two groups in total hospital expenses and long-term evaluation results.Results:All of 60 cases,the wounds healed in first stage and the transplanted tissues survived of both groups,but there was an arterial crisis occurred in the toenail flap transplantation group,which recovered well after symptomatic treatment.Statistics were used to analyze the total hospital expenses and long-term clinical efficacy of the two groups.(1)Comparison of total hospitalization costs between the two groups: the average total hospitalization cost of TF group was 14099.17 yuan,and the average total hospitalization cost of STTB group was 7259.50 yuan.The data of the two groups were tested by t-test,P<0.05,the results were statistically different.(2)Results of the long-term efficacy evaluation about reconstructed nail appearance: the result of the TF group was excellent in 25 cases,good in 3 cases,and poor in 2 cases,the excellent and good rate was93.33%;13 cases of the STTB group were excellent,7 cases were good and the difference was 10 cases.The excellent and good rate was 66.67%.The data of the two groups were tested by chi-square test,P=0.024<0.05,the results were statistically different.(3)Results of the long-term efficacy evaluation about reconstructed nail function: the result of the TF group was excellent in 29 cases,good in 1 cases,0 cases were fair and poor,the excellent and good rate was 100%.The STTB group was excellent in 27 cases,good in 3 cases,fair and poor in 0 cases,the excellent and good rate was 100%.The data of the two groups were tested by rank sum test,P=0.305>0.05.There was no statistical difference between the two groups.Conclusion:(1)The long-term efficacy about reconstructed nail appearance of free toenail flap transplantation is better than free split-thickness toenail bed when there are used to repaire the defect of fingernail bed.(2)The long-term efficacy about reconstructed nail function of free toenail flap transplantation is same as free split-thickness toenail bed when there are used to repaire the defect of fingernail bed. |
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