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Microsurgical toe-to-finger transfer of the nail system: long-term outcomes

  • Original Paper
  • Published:
European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Reconstruction of the nail unit is often a neglected entity with few reports in the literature addressing the technique of its repair. The reconstruction is done with either non-vascularized nail grafts or vascularized free nail transfers, which have the benefit of transferring the germinal matrix which allows for proper nail growth. The nail is a dynamic structure that grows and changes in shape. Long-term follow-up is a requirement to determine the success of the reconstruction.

Methods

We present eleven patients with total nail unit loss who underwent microsurgical total nail unit transfer. Six objective criteria were used to assess nail growth: Eponychial and paronychial retraction, speed of nail growth, nail orientation, adhesion to the nail bed, and the presence of nail fracture. Results ranged from “excellent” to “poor” according to the proposed score.

Results

The mean follow-up time was 16.5 months. We had no cases of total or partial flap loss. No acute complications were encountered. The short pedicle technique was used in nine of the cases while the long pedicle technique in only two cases. Six patients had “excellent” results, four reported a “good” result, and only one patient had a “fair” result.

Conclusions

Microsurgical toe-to-finger nail unit transfer is a reliable option for nail reconstruction when total nail loss is present. It holds the advantage of transferring all the components of the nail system including the germinal matrix and the cutaneous folds, which allows proper nail growth and an acceptable cosmetic outcome.

Level of evidence: Level IV, therapeutic study.

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Availability of data and material

All data in this manuscript is available upon the request of the editor. These data and material support our published claims and comply with field standards.

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Authors and Affiliations

  1. Department of Surgery - Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center - Faculty of Medicine, PO Box 11-0236, Riad el Solh, Beirut, 1107 2020, Lebanon

    Reem Karami, Paul Beaineh, Dimitri Bakhach & Joseph Bakhach

Authors
  1. Reem Karami
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  2. Paul Beaineh
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  3. Dimitri Bakhach
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  4. Joseph Bakhach
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Reem Karami, Paul Beaineh, Dimitri Bakhash, and Joseph Bakhash. The first draft of the manuscript was written by Reem Karami, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Joseph Bakhach.

Ethics declarations

Conflict of interest

Reem Karami, Paul Beaineh, Dimitri Bakhach and Joseph Bakhach declares that they have no conflict of interest

Ethics approval

This study was approved by the institutional review board at the American University of Beirut Medical Center. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study. For children below the age of 16 years informed consent was obtained from their legal guardian. Patients signed informed consent regarding publishing their data and photographs. The pictures are of hands and toes and have patient identifiers

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All code is available for publishing

Consent to participate

Informed consent was obtained from all individual participants included in the study. For children below the age of 16 years informed consent was obtained from their legal guardian.

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Patients signed informed consent regarding publishing their data and photographs.

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Karami, R., Beaineh, P., Bakhach, D. et al. Microsurgical toe-to-finger transfer of the nail system: long-term outcomes. Eur J Plast Surg 44, 355–360 (2021). https://doi.org/10.1007/s00238-020-01759-0

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  • DOI: https://doi.org/10.1007/s00238-020-01759-0

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