Treatment of Painful Nonunion of the Distal Phalanx in the Finger With Bone Graft and Dorsal Reverse Adipofascial Flap Based on an Exteriorized Pedicle.

Reconstruction of the distal phalanx bone in cases with painful nonunion is a rare and challenging problem. To restore anatomy and to provide a good cover for the bone graft, an intact nailbed is often required due to the proximity of these 2 structures. We present 3 cases of distal phalanx reconstruction performed with a free corticocancellous bone graft from the distal radius and nailbed reconstruction with a homodigital dorsal reverse adipofascial flap based on an exteriorized pedicle that avoids the dissection of the germinal matrix of the nail. All bone grafts consolidated and all flaps survived. All nail plates grew back with no deformity. In this rare but challenging problem, our combined technique appears to be a valid option that enhances the possibility of good bone healing and maximizes the cosmetic result.