Nail Reconstruction

Basic Principles

• 1. Clinical Principles of Thumb Reconstruction

  • Nail bed level amputation (nail matrix intact)

    • Volar flap + nail bed graft

  • Distal phalanx amputation (Including IP joint amputation)

    • Wrap-around flap (+ volar flap)

  • Basal phalanx amputation (distal to MP joint) Refer to Chap. 9

    • Great toe transfer

    • Twisted wrap-around flap (TWA) flap

  • Metacarpal level amputation (loss of MP joint)

    • Second toe transfer

    • Pollicization

  • Degloving injury

    Twisted wrap-around flap (+ dorsal pedis flap)

    Refer to Chap. 4

• 2. Clinical Principles of Finger Reconstruction

  • Nail bed level amputation (nail matrix intact)

    • Split-thickness nail bed graft and digital artery flap (distal phalanx bone graft from second toe)

    • Vascularized nail bed graft (with bone)

  • Nail matrix graft

    • Wrap-around flap (+ volar flap)

    • Twisted wrap-around flap

    • Second toe transfer

The difficulty level of each surgical procedure is shown subsequent to the procedure title (e.g., Level of Difficulty: 2). The levels range from 1 to 5, with level 1 indicating a preliminary level and level 5 indicating a very advanced level.