My usual practice is to make every effort to maintain the length of the fingers to prevent permanent damage to the aesthetic appearance and function of the hand.
If there is a bone exposure, I try to prevent the occurrence of infections and secondary complications by promoting the regeneration of the skin, or the execution of full thickness skin grafts from the ulnar part of the hand, the forearm or the groin to reduce the healing time.
Otherwise, a microsurgical reconstruction with the use of local, regional or distant flaps is mandatory and gives an excellent result. For lesions involving the nail apparatus I’m really disappointed in taking care of patients referred from other centers not specialized in hand surgery without anatomic reconstructions with a final permanent disorders of growth and function of the nail. It’s well known the importance of the nail as a structure that not only gives a good appearance to the hand but also for grasping objects.
The possibility to reconstruct the nailbed or the nail apparatus as a whole with a transplantation from the foot to the hand, or the choice of a pure aesthetic solution with nail specialists, render the result optimal.