Acellular dermal matrix reconstruction of a nail bed avulsion in a 13-year-old child

The Expanded Application of the Acellular Dermal Matrix: Traumatic Nail Bed Defect of the Digits

Reconstruction of traumatic nail bed defects in the digits is a frequently encountered procedure, yet often presents many challenges. In such scenarios, staged procedures may be required with significant limitations in shape and increased donor site morbidity, particularly when multiple defects are present. In this study, we introduce a simple method for the reconstruction of nail bed defects using an acellular dermal matrix (ADM). The study involved 19 digits with nail defects, which underwent reconstruction using an ADM graft. The surgical procedure was performed on all patients on the day of injury, after which they were promptly discharged. The dimensions of the defect ranged from 0.5 × 0.5 cm to a maximum of 2 × 3 cm (average, 0.9 × 1.4 cm). Final examinations were performed at postoperative 5-11 months (average, 6.6 months). All ADM grafts were successfully taken. Nail growth was observed at an average of 4 months after surgery in the treated finger. The surgical results were retrospectively evaluated using the Zook criteria. Outcomes were "excellent" in 11 patients (57.9%), "very good" in five patients (26.3%), "good" in two patients (10.5%), and "fair" in one patient (5.2%). The expanded application of ADM explored in this study illustrates a straightforward method for the reconstruction of traumatic nail bed defects, providing effective results in a single stage without incurring donor site morbidity.