Journal of Hand Surgery - June 2022 - S435

Abstract
S435
antibiotics as per local guidelines. Following positive
cultures, the antibiotic regime had to be amended in
26 cases (40.0%).
Conclusions: Whilst risk factors for most infections
include increasing age and underlying diseases, the
majority of our patient cohort were young fit males. A
low threshold for surgical debridement is recommended
in combination with intravenous flucloxacillin.
In severe infections, concurrent clindamycin is
now recommended locally for streptococcal
infections.
A-2157 Nail Trephination Versus Nailbed Repair In
Subungual Haematoma: Does The Method Of
Treatment Affect Outcome?
Saw Sian Khoo, Chee Chen Hue,
Jayaletchumi Gunasagaran, Sachin Shivdas,
Shams Amir Shamsul Bahar and
Tunku Sara Tunku Ahmad Yahya
National Orthopaedic Centre ofExcellence in Research and
Learning (NOCERAL), Kuala Lumpur, Malaysia
Objective: To assess whether subungual haematoma
with intact nail plate should be treated with simple
trephination or formal nail bed repair based on functional
and cosmetic outcome of the healed nail.
Methods: A randomised controlled trial in a single
centre, large teaching hospital. Inclusion criteria:
Acute subungual haematoma, occurring within 48
hours of presentation, and involving more than 50%
of nail surface; intact nail and nail margin; willing to
return for follow-up. Exclusion criteria: Infected
nailbed injury, previous nail abnormality, associated
distal phalanx fracture requiring surgical fixation.
Trephination group: Evacuation of subungual haematoma
by trephination alone using 18-gauge needle
under aseptic technique. Operative group: Nail
plate removal and repair of nail bed laceration
using 6-0 Vicryl under local anaesthesia. Follow up
at 2 weeks, 1 month, 3 months and 6 months.
Outcome measures: DASH questionnaire and
patient-perceived functional and cosmetic problem
via a scale of 0 to 10 on overall pain, stiffness, sensation,
appearance and satisfaction. Two independent,
blinded doctors assess cosmetic outcome of
new nail as per Zook's criteria at 6 months.
Results and Conclusions:
Pending. (This study is in progress and will be completed
in January 2022)
A-2158 Modified Great Toenail Flap with
Preservation of Partial Toe-nail for Aesthetic
Reconstruction of Thumb and Fingers
S.-L. Xie, B. Hou, M.-J. Liu, Z.-X. He, X.-J. Huang and
X.-J. Xiao
Affiliated Nanhua Hospital, University of South China
Hengyang, China
Objectives: To illustrate the surgical methods and
clinical efficacy of modified great toenail flap with
preservation of partial toenail for aesthetic reconstruction
of thumb and fingers.
Methods: Between 2013 and 2018, 43(2 cases of
thumb defect and 41 cases of other fingers defect)
patients underwent reconstruction with our
improved microsurgical approach. Bilateral combined
half great toenail flap and unilateral great toenail
flap were harvested to reconstruct thumb and
fingers, respectively. The donor site of great toenail
flap was repaired by artificial dermis. At the
final follow-up visits, static two-point discrimination,
visual analogue scale, Michigan hand outcome questionnaire,
Foot and Ankle Disability Index score, and
return-to-work(RWT) time were used to evaluate
surgical outcomes.
Results: All cases survived well. The contour of the
reconstructed digits was similar to the contralateral
one. Follow-up period ranged from 6 to 30 months
(mean 18 months), mean two-point discrimination of
reconstructed digits was 6.2mm (range, 4 to 8 mm).
The average VAS scores for the aesthetic appearance
of the donor site 9.2 (range 8.5-9.7). The average
Michigan Hand Outcome Questionnaire (MHOQ)
score for hand function (reconstructed hand) was
8.5 (range 6-15). Mean Foot and Ankle Disability
Index score was 98(range 96-100). The average
RTW time was 12.4 weeks (range 9-15 weeks).
Conclusions: Reconstruction of thumb and fingers
with a modified great toenail flap, preserving partial
toenail, results in excellent contour and functional
outcome for surgical site. Donor site morbidity in
the foot was minimal.
A-2161 Combined Using of Microsurgical Technique
and The Palmar Subcutaneous Pocket Method:A
New Strategy for Salvage of the Amputated
Fingertip
B. Hou, S.-L. Xie, M.-J. Liu, Z.-X. He, X.-J. Huang and
X.-J. Xiao
Affiliated Nanhua Hospital, University of South China
Hengyang, China
Journal of Hand Surgery - June 2022

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