The Top-Hat Flap: A New Technique for Segmental Nailbed Reconstruction
Bibliographic record
Abstract
SUMMARY: The finger or thumb tip was used as a homodigital neurovascular island flap ("top-hat flap") to reconstruct 28 segmental defects of the distal phalanx, nailbed, or pulp over a 7-year period with a minimum follow-up of 12 months. All flaps survived and all fractures united. A total of 75% of patients achieved full range of motion at the distal interphalangeal joint, 71% achieved 2-point discrimination of less than 6 mm, and 92% returned unrestricted to their preinjury job less than 3 months after injury. The average digit impairment score, based on the American Medical Association's Guides to the Evaluation of Permanent Impairment, Fifth Edition , was 19%. The top-hat flap is an option for the treatment of complex injuries of the finger or thumb tip where there is a segmental defect in the nailbed, distal phalanx, or pulp and a neurovascularly intact finger or thumb tip. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".