Split-Thickness Nail Bed Flap Graft in the Management of Distal Partial Defect of the Nail Bed Combined With Soft Tissue.

PURPOSE: We report a surgical procedure for the management of nail bed injuries combined with soft tissue defects.

METHODS

We reviewed the records of patients with a nail bed injury combined with a soft tissue defect, who were surgically treated at our hospital from 2015 through 2018. According to the Allen classification, 5 patients were characterized as type 2 and 3 were characterized as type 3. Two also had partial defects of the distal phalanx. In all cases, we created a split-thickness nail bed flap of the great toe to reconstruct the nail bed injury. All patients underwent supervised postoperative rehabilitation. We reviewed patients' medical records for the Michigan Hand Outcomes Questionnaire, 2-point discrimination, and postoperative healing in the donor area.

RESULTS

Both the nails and flaps of all patients survived. No complications were observed after surgery. The nail was completely attached to the nail bed. In addition, there were no deformities, and the nail plate appearance was close to normal. A nail with an unsatisfactory appearance was noted in one patient. The shape, texture, and elasticity of the flaps of all patients were acceptable. All patients were capable of normal pinching, gripping, and grasping. Twelve months after the operation, 3 of 8 patients had 2-point discrimination of 6 mm or less. All patients were satisfied with the hand function according to the Michigan Hand Outcomes Questionnaire. The toenail of the donor site grew well, and no deformity or pain with walking was noted.

CONCLUSIONS

We demonstrate that this approach is a safe means of repairing a nail bed injury combined with a soft tissue defect.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.