Combined Technique of Local Finger Flap and Partial Toe Flap for Finger Nail Reconstruction

Abstract

BACKGROUND: Toe transfer operation for nail reconstruction of the hand is an established technique. However, although reconstruction of a cosmetic nail at the recipient site has become possible, the problem of the donor site in toes has not disappeared. The greatest problem of the conventional wrap-around flap method is a postoperative skin ulcer at the donor site of the toe because a large skin flap is harvested from the great toe and surgical dissection is invasive to the weight-bearing region. The authors have developed a new method for avoiding postoperative skin ulcer formation at the donor site. It consists of a combination of a finger flap elevated at the recipient site and a partial toe flap harvested from the great toe without dissecting the weight-bearing region. METHODS: A local finger flap is elevated at the recipient site and a partial toe flap including the nail is harvested from the great toe. They are combined to make a finger. Using this procedure, the size of the partial toe flap is slender and the weight-bearing region remains intact. The donor site wound is closed with artificial dermis once, and skin grafting is performed at 3 weeks after surgery. RESULTS: This procedure was performed in 31 fingers of 30 patients. In 2 smokers who were older than 60 years old, the partial toe flaps became necrotic but in the other 28 patients, flaps survived well and aesthetic fingertips were achieved. In all patients, the weight-bearing region of the great toe was intact and there was no trouble walking after surgery. CONCLUSION: Surgical invasion to the weight-bearing region may produce a skin ulcer postoperatively. However, the combination of a local finger flap and a partial toe flap results in a smaller skin defect of the great toe. This new concept of nail reconstruction is minimally invasive and simpler as a surgical technique.