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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Reconstruction of a Nail Unit Using a Free Composite Flap Harvested from the Great Toe with Nerve Repair in 25 Patients

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  • presenting/speaker Xu Zhang - Third Hospital of Hebei Medical University, Shijiazhuang, China
  • Yadong Yu - Third Hospital of Hebei Medical University, Shijiazhuang, China
  • Guisheng Zhang - Third Hospital of Hebei Medical University, Shijiazhuang, China
  • Xinzhong Shao - Third Hospital of Hebei Medical University, Shijiazhuang, China

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-903

doi: 10.3205/19ifssh0449, urn:nbn:de:0183-19ifssh04492

Published: February 6, 2020

© 2020 Zhang et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: To introduce reconstruction of a nail unit defect in the finger using a free composite flap taken from the great toe, including neurorrhaphy between the dorsal digital nerve of the great toe and the dorsal branch of the proper digital nerve of the injured finger.

Methods: From May 2015 to May 2017, 25 fingers in 25 patients with traumatic nail unit defects were treated. The mean size of the germinal matrix and sterile matrix defects was 6 mm × 8 mm (range, 4 mm × 6 mm to 7 mm × 10 mm), and the mean size of the nail bed flaps was 7 × 9 mm (range, 5 mm × 7 mm to 8 mm × 11 mm). The mean length of the arteries that the flap based was 2.4 cm (range, 1.9 cm to 3.1 cm). For comparison, we also collected 21 patients without nerve repair from January 2012 to January 2015. Outcomes were rated using the Zook et al.'s method. In the study group, full flap survival was achieved in all patients.

Results: At the mean follow-up period of 28 months (range, 24 to 31 months), there were 15 excellent, 6 very good, 4 good results. In the comparison group without nerve repair, there were 7 excellent, 3 very good, 2 good, 6 fair, and 3 poor results. Donor site morbidities were similar in both groups.

Conclusions: The use of a free composite flap taken from the great toe is a useful technique for reconstructing nail unit defects in the finger, and no obvious donor site morbidity exists with the use of the dorsal branch of the proper digital nerve.