Modified method of Hallux toe nail flap for finger tip reconstruction and donor site repair

Abstract

Objective To discuss the modified method and clinical effect of free hallux toe nail flap for reconstruction of composite tissue defect at finger tip and repair of its donor site. Methods Partial nail bed at fibular side of hallux was cut and combined with toe tip skin to form hallux toe nail flap. The reconstruction of finger tip defects was achieved by free hallux toe nail flap transplantation. The donor site of hallux was sutured directly. Nail bed wound was healed by itself without skin graft or flap repair. From May 2013 to April 2015, 13 cases (15 fingers) had partial nail bed and skin defects at finger tip and no obvious distal phalanx defects, which were repaired by this method. Results All the patients were follow-up for 3 to 12 months. All the free hallux toe nail flap graft survived. The finger tip appearance and nail growth were close to normal. The function of interphalangeal joint was good. Hallux nail was nearly complete with good appearance and without obvious defect. No local pain, ulceration, and sensory disorder occurred at hallux donor site. Conclusion Hallux toe nail flap is an ideal method for reconstruction of composite tissue defect at finger tip. The improvement of donor site repair method can make better appearance of toe tip and nail without obvious sequelae. Key words: Finger injuries; Surgical flaps; Free tissue flaps; Fingertip defects