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Ercin et al. Plast Aesthet Res 2020;7:38 I http://dx.doi.org/10.20517/2347-9264.2020.56 Page 5 of 7

Figure 5. For this case, the thickness and stability of the nail bed was suitable, so grafting was performed through the incision in the
middle of the nail bed

Figure 6. Six months after the olecranon bone grafting, the bony healing was complete

in nonunion in the 3rd finger, as confirmed by x-rays taken in the 6th week [Figure 3]. At 7 weeks after the
first operation, an arthrodesis with an olecranon graft was performed on the 3rd distal interphalangeal joint
[Figure 4]. The thickness and stability of the nail bed were suitable, so grafting was performed through the
incision in the middle of the nail bed [Figure 5]. Six months after the olecranon bone grafting, the bony
healing was complete [Figure 6].

DISCUSSION
[4]
Prehensile ability is essential for hand functions and requires a sensible and stable fingertip grip .
Whenever it is technically possible, distal fingertip replantation is the gold standard method for replacing
[2]
a missing fingertip . Replantation gives the best result, both cosmetically and functionally, in fingertip
amputations, but the functional outcome depends on sensory recovery and stability. A nonunion impairs
the stability of the fingertip .
[5]
Bone fixation methods used for replantation should be simple, rapid, and consistent, so they should cause
[5]
minimal injury to bone and soft tissue . The reported nonunion rate after replantation is between 3% and
19% in different studies [1,6-8] . Autologous bone grafts harvested from the iliac crest are commonly used
in reconstructive surgery. The bone promotes bone healing in fractures and provides structural support
[9]
for reconstructive surgery . Iliac bone grafting can be performed under general anesthesia, but major
complications include abdominal hernia, vascular injuries, deep infections at the donor site, neurologic
injuries, hematoma, and iliac bone fractures. Harvesting of an iliac crest bone graft can, therefore, be
[10]
associated with significant morbidity .