Comparative Outcomes of Rectangle Recession Versus Eponychial Folding Flaps for Nail-Plate Length After Fingertip Amputation

Purpose Fingertip amputations affect the distal phalanx, pulp, and nail complex, with considerable impact on both function and appearance. Although various flap techniques are used for soft-tissue coverage, restoration of apparent nail-plate exposure is often neglected. This study aimed to compare the functional and aesthetic outcomes of two apparent nail-plate exposure techniques, the rectangle recession flap and the eponychial folding flap, in patients with fingertip amputations. Neither technique creates new nail tissue; both modify the proximal nail-fold to expose a greater proportion of the already-present nail-plate. Methods This was a prospective comparative study conducted from June 2023 to June 2024 at a tertiary care specialty hospital. Sixty patients with fingertip amputations were randomized using sequentially numbered, opaque, sealed envelopes into the rectangle recession flap group (group A, n=30) or the eponychial folding flap group (group B, n=30). A biostatistician was involved in both sequence generation and statistical validation. Patients were assessed at regular intervals over a 3-month postoperative period. Primary outcome measures included apparent gain in visible nail-plate exposure (as a percentage of the contralateral normal), scar quality, sensation, and overall aesthetic satisfaction using validated scoring systems. Results The study revealed significant differences between the two techniques in terms of apparent gain in visible nail-plate exposure and functional outcomes. Patients who underwent the eponychial folding flap technique demonstrated superior outcomes, particularly in terms of visible nail-plate exposure, scar quality, appearance, and postoperative pain. Conclusions Both techniques are viable options for increasing apparent visible nail-plate exposure in fingertip reconstruction; however, the eponychial folding flap provides superior outcomes in terms of visible nail-plate exposure, scar quality, and aesthetic restoration, and may be preferred in appropriate cases. Type of study/level of evidence Therapeutic IV.