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Letter Regarding “Oblique Triangular Neurovascular Osteocutaneous Flap for Hook Nail Deformity Correction”

      To the Editor:
      We read with interest and commend the authors
      • García-López A.
      • Laredo C.
      • Rojas A.
      Oblique triangular neurovascular osteocutaneous flap for hook nail deformity correction.
      on their endeavor to solve a common yet difficult problem. The authors present a well-written article with supporting photographs and diagrams to facilitate the adoption of their new technique. Nevertheless, careful examination of these supplementary items reveal points that raise concern regarding this technique and its potential use.
      Our first concern regards the position of the K-wire to support the osteocutaneous flap. Both the radiographs and diagrams show that the K-wire is sited within the flexor digitorum profundus (FDP) tendon. This position has increased risks of abrasion, rupture, or infection, and we would ask why the K-wire is not placed within bone instead?
      The authors also mention releasing part of the insertion of the FDP. This would increase the risk of rupture to the FDP tendon.
      In the preoperative photograph the nail is not trimmed, yet in the postoperative photograph it is. This suggests that the patient continues to have a hook nail deformity after the flap. It would be judged that there is no improvement in the position of the full edge of the sterile matrix. This raises questions regarding its efficacy given its technical difficulty and potential complications.
      One more minor point, Figure 2 shows an FDP insertion point far too proximal. This makes it appear that the amount of bone available to osteotomize and move is much larger. This could be misleading.
      Finally, the authors present their technique in one patient. We believe that a series of such cases would perhaps add weight to the efficacy and reliability of this technique with regards to outcomes and potential complications.

      Reference

        • García-López A.
        • Laredo C.
        • Rojas A.
        Oblique triangular neurovascular osteocutaneous flap for hook nail deformity correction.
        J Hand Surg Am. 2014; 39: 1415-1418

      Linked Article

      • Oblique Triangular Neurovascular Osteocutaneous Flap for Hook Nail Deformity Correction
        Journal of Hand SurgeryVol. 39Issue 7
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          Hook nail deformity results in aesthetic and functional problems after fingertip amputations. Previously described techniques do not correct the osseous defect, which may be the principle cause of the problem. We present a surgical technique based on a compound homodigital advancement flap combining bone of the distal phalanx, finger pulp, and skin. We describe this technique, report a case, and discuss the advantages over former techniques.
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