Reconstruction of Nail Defects

Abstract

The tip of the finger is exposed to the farthest end of the limb, which is the most vulnerable to injury in labor and life. The traditional method is finger amputation, which often results in type I or type II defect; Such as the use of local flap, the length of finger body is retained, but the finger end is dry, the flap has no feeling, the dorsum of the finger is without fingernails that would cause a certain degree of disability. Because the function of the hand is special, in addition to labor and life, it is also an important organ of social activities and mutual communication just like the face. Therefore, the standard of the repair and reconstruction of thumb and finger defects should be improved correspondingly. Instead of simply repairing the wound surface, anatomical and physiological repair with consistent function and appearance should be pursued. In 1980, Morrison et al first applied the great toenail flap graft to repair the skin sleeve avulsion of the thumb successfully, and it has been widely used because it reappears the complete shape of the thumb.

Traditionally, fingernail defect has no obvious effect on finger function that doesn’t need to be reconstructed. However, with the development of microsurgical technology, there is no problem with the technique of toenail transplantation to reconstruct the fingernail, and its surgical method and difficulty are similar to that of the fingertip reconstruction. Therefore, nail reconstruction is feasible for nail defect patients with high demand for finger aesthetics. The commonly used methods for nail defect reconstruction include: great toenail flap transplantation, half great toenail flap transplantation, second toenail flap transplantation, and other toenail flap transplantation. Generally speaking, great toenail flap is large, which has a great influence on great toe; The second toenail flap is small and the shape is poor after reconstruction. Half great toenail flap has relatively high technical requirements, better shape, and less injury. Specific plan should be selected according to the size of fingernail bed, soft tissue defect, and bone defect.