Toenail Flap Research Articles

Reconstruction of Composite Soft Tissue Defect in the Distal Finger Using Partial Toenail Flap Transfer.

Composite tissue loss involving the distal finger pulp and the nail is a common but challenging finger injury to restore. This study introduces a reconstruction procedure for a distal finger pulp and nail defect using a partial toenail flap transfer. Twenty digits, including 16 thumbs, two index fingers, and two middle fingers, with composite soft tissue defects were treated with a partial toenail flap transfer from October 2015 to January 2020. Shortening revision of the great toe phalanx, a V-Y advancement flap of the toe pulp, and a local pedicle flap from a second toe transfer were used to cover the donor sites, and no skin grafts were required. Functionality was evaluated using the validated Spanish version of the Quick-DASH scale. The aesthetics of both the reconstructed and donor sites were evaluated using the Vancouver Scar Scale (VSS). The static two-point discrimination (2-PD) of the finger pulp was used as a measure of tactile agnosia. All donor site wounds healed well. The average follow-up time was 23.6 months (6-39 months). The mean Quick-DASH functional score was 7.1. The VSS scores were 4.02 ± 0.29 and 4.00 ± 0.38 for the reconstructed and donor sites, respectively. The static 2-PD of finger pulp was 4.5 ± 0.76 mm. The patients were satisfied with finger motion, sensory function, and aesthetic contour. Partial toenail flap transfer is the recommended treatment to regain motion, sensation, function, and a satisfactory aesthetic appearance when considering repairing a composite soft tissue distal finger defect with accompanying loss of the perionychium, particularly in the thumb, index finger, or middle finger.

The reconstruction of fingertip injury by mini hallux toenail flap pedicled with the hallux transverse artery and toe pulp vein transplantation technique based on the equivalent design theory

IntroductionHow to reconstruct the damaged fingertip is a clinical problem. Our team propose the theory of equivalent design and use the mini toenail flap pedicled with the hallux transverse artery and toe pulp vein transplantation technique to reconstruct Allen’s type II fingertip injury. Thus, we perform the retrospective study to evaluate the effects of this technique on fingertip injury.Materials and methodsA retrospective analysis was performed on 56 patients admitted to our hospital from January 2015 to January 2020 who used equivalently designed miniature hallux toenail flaps for the plastic repair of fingertip damage. We recorded the size of the miniature hallux toenail flap, operation time, intraoperative blood loss, and complications and calculated the survival rate of the transplanted miniature hallux toenail flap. During routine follow-up after surgery, we recorded nail growth time and observed finger appearance. At the last time of follow-up, we recorded Semmes-Weinstein evaluating tactile sensation and Two-point discrimination testing (TPD). The efficacy was evaluated by Zook score evaluation.ResultsThe size of the mini hallux toenail flap was 0.71 cm × 1.22 cm to 0.88 cm × 1.71 cm. The operation time was (3.54 ± 0.58) hours, the intraoperative blood loss was (20.66 ± 4.87) ml, and the survival rate of mini hallux toenail flaps was 100%. The postoperative follow-up time was (30.82 ± 11.21) months, and the total nail growth time was (9.68 ± 2.11) months. The average tactile sensation evaluated by the Semmes-Weinstein test was (0.32 ± 0.14) g, and the average TPD was (7.33 ± 1.02) mm. According to Zook score, the curative effect of fifty-six cases were all excellent or good with 100% excellent and good rate, and all patients had beautiful appearances and good function of damaged fingertips.ConclusionsBased on the equivalent design theory, the mini hallux toenail flap pedicled with the hallux transverse artery and toe pulp vein transplantation technique is an effective method to reconstruct Allen’s type II fingertip injury with a beautiful appearance and good function.Type of study/level of evidenceTherapeutic IV.

Reconstruction of fully shaped fingers using a free great toe nail flap combined with a second toe tissue flap.

To explore the clinical outcome of a free great toe nail flap (GTNF) combined with a second toe tissue flap (STTF) for fully shaped finger reconstruction (FSFR). From January 2013 to January 20, 2019, patients with finger defects underwent finger reconstruction using free GTNF combined with an STTF. All 20 fully shaped, reconstructed fingers survived without complications. The average follow‐up time was 44.4 months (range 12‐60 months). The reconstructed fingers had better function and appearance. The length of the fingers was close to normal, and the joint positions were normal. The fingers were able to extend −15° to −5° and flex 40° to 85°. The reconstructed fingers had no pain or numbness, and the function of the feet was restored well. The reconstruction of fully shaped fingers using GTNF combined with an STTF results in better function and appearance. This surgical method is worthy of promotion. This article introduces a new surgical method that is related to finger reconstruction. Finger defects bring psychological and functional regrets to patients and their families. Through this operation, the reconstructed finger is more perfect in appearance and function. I think this technology is very effective and worth promoting.

Free Flap Reconstruction of Extremity Defects in Pediatric Patients

Abstract Background Microsurgical reconstruction of extremity defects with free flaps has been carried out for many years. The aim of this retrospective study is to characterize free flap surgery on children of 1 to 7 years old by evaluating a series of 20 cases of free flap surgeries that have been performed in pediatric patients. Methods From February 2014 to January 2018, 20 patients, 10 boys and 10 girls aged from 1 to 7 years (average, 4.6 years), were engaged in this study. Several types of free flaps were used, including anterolateral thigh flaps (ALT), inferior ulnar collateral artery flap, latissimus dorsi flap, medial plantar flap, fibular osteocutaneous flap and hallux toenail flap. After operations, follow-up period was at least for 2 years and the average follow-up period was 48.5 months. The long-term outcomes were estimated by questionnaires derived from the American Academy of Orthopaedic Surgeons Pediatric Outcomes Data Collection Instrument (PODCI). Results A total of 21free-flap reconstructions were performed on 20patients, including 15 ALT, 3 composite flaps, and 3 other cutaneous flaps. The size of the tissue flap ranged from 1.5 to 280 cm2 (average, 74.1cm2). The diameter of the anastomosed artery of the flap ranged from 0.7 to 1.2 mm. Among the 21 flaps, 20 survived and the success rate was about 95 %. Contour adaption was achieved in all flaps. Fifteen children received a secondary operation for debulking or functional improvement. Secondary deformity was present in 3 children, among which ankle joint valgus was seen in two children and a flexion deformity of injured toe occurred in one child. The mean global functioning score of PODCI was 94 (ranging from 81 to 98, maximum 100). Conclusion The success rate of free-flap surgery in pediatric patients was comparable to that achieved in adults. Post-operative caring for pediatric patients was easier than expected. For pediatric patients, the final outcomes were not varied remarkably from different types of free tissue transfer.

Cosmetic and functional results of a newly reconstructed thumb by combining the phalanx of second toe and the great toenail flap transplantation

BackgroundMicrosurgical toe-to-hand transfer is a gold standard when it comes to repairing a thumb defect. Great toenail flap, thumbnail valva flap, free great toe, and second toe transplantation are the common methods in thumb reconstruction. Second toe transplantation achieves good function, but poor esthetics. Great toe transplantation achieves better esthetics, but hindered walking, due to the foot’s loss of the great toe and moreover suboptimal thumb function. It is difficult to maintain both functional and esthetic satisfaction in thumb reconstruction.MethodsWe experimented with three different methods of toe to hand transfer. From October 2009 to July 2019, 30 patients with traumatic thumb defects received one of 3 different kinds of thumb reconstruction in our clinic according to their level of amputation. Divided evenly into three groups of ten, group one received a great toe transplantation, group two received a second toe transplantation, and group three received a combined great toenail flap and second toe phalanx transplantation. Each of the patients’ thumbs had different levels of amputation at the metatarsophalangeal joint (MPJ) or distal interphalangeal joint (DIPJ).ResultsOne patient suffered from a partial flap necrosis and received a groin flap to cover the defect. No other thumbs had any complications. The functional and esthetic results of both the donor and the recipient sites were satisfactory. Results show that, for patients with traumatic thumb defects, the combined transfer of flap and second toe phalanx was the best option.ConclusionsCompared to the great toe or second toe transfer, combined free transfer of the great toenail flap and second toe phalanx achieved a substantially better functional and esthetic result in the thumb reconstruction.

Aesthetic Reconstruction of Fingers and Thumbs With the Vascularized Half–Big Toenail Flap With Minimum Donor Site Morbidity

PurposeThe vascularized half–big toenail flap is a short-pedicle free vascularized flap approximately 30 mm in size that contains a fibular half-nail with a 5-mm skin edge and the partial distal phalanx bone. The fingertip skin of the amputated finger is reflected to cover the skin deficiency. The sensation and function are maintained at the donor site, and primary wound closure of the donor site is possible. This study aimed to evaluate the clinical outcomes of thumb and finger reconstruction operations performed using this flap.MethodsWe assessed 16 patients (19 digits) with digit amputation who underwent this procedure. We evaluated the following parameters: reconstructed digits, amputation level, survival rate, period until bone union, elongated length, morphologic indices, feeding artery, vein distribution, static 2-point discrimination, and patient occupation. We used the Michigan Hand Outcomes Questionnaire for the evaluation of the function and appearance of the arm.ResultsWe reconstructed 3 thumbs and 16 fingers. No patients with zone I or V or palm amputation underwent surgery. Flap survival was obtained in all cases, including one atrophic case. Elongated length was 14.1 mm (range, 0–30 mm). The width and longitudinal/axial convexity of the transferred nail increased and the length decreased, whereas the width of the donor site nail increased at final follow-up. Reasonable sensation of the flap was obtained. The feeding artery was the plantar digital artery in 15 toes, the branch in 1, and the arterial anonymous vessel in 3. We could harvest the vein in the first web in 16 toes. All patients went back to their former jobs.ConclusionsThe aesthetic and functional outcomes of the reconstructed thumbs and fingers significantly improved. Donor site functional morbidity was minimum. Nevertheless, patients’ expectations regarding the reconstructed digit seemed to be that of an intact digit.Type of study/level of evidenceTherapeutic IV.

周術期皮弁血行動態の変化から動脈化足趾爪静脈皮弁の生着過程の分析を行った 2 症例

周術期皮弁血行動態の変化から動脈化足趾爪静脈皮弁の生着過程の分析を行った 2 症例

Application of free big toe nail bone flap combined with second toe tibial flap for reconstruction of thumb defect

Objective To introduce a modified method of thumb reconstruction by combined transplantation of free big toe nail bone flap and second toe tibial flap. Methods According to the condition of thumb defect, free big toe nail bone flap and second toe tibial flap with the common vascular pedicle were cut from the first and second toes of the ipsilateral foot. The second toe tibial flaps were transversely transferred to the tibial side of the toe nail bone flap to reconstruct the toe nail flap belly and nail folds, improve the shape of the reconstructed thumb and reduce the damage of the donor site. Results All the 7 cases survived and the donor and recipient wounds achieved primary healing. The postoperative follow-up period ranged from 3 to 15 months. The reconstructed thumb had good appearance and normal function. According to the functional evaluation criteria of the upper limb issued by the Hand Surgery Society of Chinese Medical Association, the results were graded as excellent in 5 cases and good in 2 cases. All the patients could manage their activities of daily living independently. The donor site had little injury, good shape and function. Conclusion The method of reconstructing thumb defect with free big toe nail bone flap combined with second toe tibial flap can effectively improve the appearance of reconstructed thumb, make the reconstructed thumb symmetrical, beautiful and functional, and reduce the damage of donor toes. Key words: Thumb; Surgical flaps; Second toe; Reconstruction

Repair of thumb defect by using the toenail flap: biomechanical analysis of donor foot\u2014a retrospective cohort study

BackgroundThe thumb accounts for 50% of the total hand function. This study reports the functional outcomes and complications of people with traumatic thumb amputations who underwent toe-to-thumb reconstruction.MethodsFrom January 2013 to January 2018, 29 patients with second-degree thumb defect underwent thumb reconstruction with distal phalangeal braided toenail flap. The footscan foot pressure gait analysis system was used to measure the index changes of the same foot before and after 1, 3 and 6 months. The contact area, peak pressure, impulse value, contact time of each gait phase, centre of gravity coordinate and foot balance were analysed statistically.ResultsTwenty-nine cases of thumb reconstruction recovered well. After following up for 6–15 months, the appearance of the reconstructed thumb was close to normal, and the sensation was restored to S3+. The two-point discrimination was 6–8 mm, and the function of the thumb was good. The function of the donor foot was well restored, and no skin ulceration, pain and claudication were noted during walking. Compared with that before the operation, the biomechanical indices of the donor foot were basically restored to normal 6 months after the operation. Only the stress and impulse values of the third metatarsal head were significantly increased, forming a stress concentration area centred on the third metatarsal head.ConclusionsThis study confirmed that the toenail flap with distal phalangeal bone restored the second-degree thumb defect without destroying the main functional structure of the sole. The biomechanical indices of the donor foot were basically restored to normal 6 months after the operation. Only the stress concentration area centred on the third metatarsal head, and the pain on the forefoot was induced after the operation. Discomfort, callus formation, metatarsal fasciitis, etc., can lead to fatigue fracture of the third metatarsal bone in severe cases, which requires further follow-up and observation.Trial registrationClinicaltrials.gov, NCT03879941; registered on 10 March 2019, retrospectively.

Repairation of composite distal soft tissue defect of thumb and finger with mini toenail flap

Objective To introduce the repairation procedure of composite distal soft tissue defect of thumb and finger with mini toenail flap. Methods From June, 2015 to June, 2018, 7 cases with composite tissue defect at 7 distal fingers, including 5 thumbs, 1 index finger and 1 middle finger, were reconstructed with mini toenail flap transfer. The flap sizes which were raised during the operation ranged from 4.5 cm×3.0 cm-3.0 cm×1.5 cm. The donor sites were covered by toe phalanx shortening, V-Y advancement flap and local pedicle flap. Microsurgical routine treatment was made after the operation, and followed-up regularly. Results Seven flaps of 7 cases completely survived without any necrosis. All the wounds at the donor sites healed well. All patients were followed-up for 6-36 months. The motive, sensor and cosmetic result were satisfied. In sensory function, the two-point discrimination distance could restore to be 4-6 mm. Conclusion The mini toenail flap transfer is a reliable and suggested method. It can anatomically restored the distal digit sensor function with cosmetic contour, and regain the motive, sensory function and satisfied cosmetic appearance. Key words: Toenail flap; Toe transplantation; Finger; Repairation; Distal finger defect

Repair of Thumb Defect by Using the Toe Nail Flap

Repair of Thumb Defect by Using the Toe Nail Flap

3D printing technology to assit in the repair of 9 cases of severe damage to the radial side hand

Objective To evaluate the value of 3D printing technology to assist in the repair of severe damage to the radial side hand. Methods From March, 2014 to September, 2016, there were 9 cases suffered from varying degrees of metacarpal and phalangeal bones injuries with soft tissue destruction at the radial side of the hand. The donor and recipient areas were scanned by 64 row spiral CT before operation. Three dimensional images were obtained by CTA 3D reconstruction technology. Preoperative plan was designed by using Mirror image technology and Virtual surgery aided design technique of Mimics software virtual surgery aided design system. Nine cases were treated with first toe toenail flap with dorsal foot flap combined with second phalangeal bone transplantation to reconstruct thumb and anterolateral thigh perforator flap to repair the wound. The cutting area of the dorsalis pedis flap and anterolateral thigh perforator flaps ranged from 4.0 cm × 5.5 cm to 6.5 cm × 9.5 cm and from 9.5 cm × 17.0 cm to 12.0 cm × 25.5 cm, respectively. Postoperative followed-up was performed to evaluate the effect of the operation. Results All 9 thumbs and flaps survived after the operation. Postoperative followed-up time ranged from 8 to 16 months. The appearance of reconstructed thumb was close to normal, and the two-point discrimination was from 8.0 to 11.0 mm. According to the evaluation criteria of upper limb function of the Chinese Academy of Medical Sciences, 7 cases were excellent and 2 cases were good. The survival flaps had soft texture, good blood circulation and satisfactory appearance at the repaired site. Conclusion 3D printing technology assists thumb reconstruction and wound repair for severe damage to the radial side of the hand with good clinical results. Key words: Destruction of the radial side of the hand; Thumb reconstruction; 3D printing technology; Anterolateral thigh flap; Microsurgical operation

Application of lower leg perforator flap for repair of the soft tissue defects in the donor site of toe transplantation

Objective To explore the clinical effects of lower leg perforator flap in the treatment of the soft tissue defects in the donor site of toe transplantation. Methods From December 2015 to December 2016, 15 cases of thumb or finger defects were reconstructed by the transplantation of big toe nail flap, the fibula side flap of great toe and second toe wrap-around flap. Simultaneously, the free peroneal artery perforator flap or posterior tibial artery perforator flap was used to repair the soft tissue defects in donor site of toe transplantation. Results All the reconstructed fingers and thumbs survived. All the flaps used to cover donor site of the foot survived. The follow-up time ranged from 1 to 18 months with an average of 8.6 months. The donor site of toe transplantation recovered well without influence on wearing shoes and walking. According to the Maryland foot function scoring system issued by Sanders et al, the results were rated as excellent in 14 cases and good in 1 case. Conclusion Lower leg perforator flap for repair of the soft tissue defects in the donor site of toe transplantation can not only reconstruct the good appearance and function of thumbs and fingers, but also can restore the integrity of donor foot. The function and appearance of the foot are well recovered. Key words: Surgical flaps; Treatment outcome; Soft tissue defects; Toe donor site

The Observation of the Vein Distribution of a Partial Toe-Transfer Flaps with a Short Vascular Pedicle.

When performing partial toe-transfer flaps with a short vascular pedicle, as the flap becomes smaller, the likelihood of securing veins in the flap decreases. The purpose of this study was to clarify how frequently the partial toe-transfer flap with a short pedicle (free vascularized half-big toenail flap) contains veins and elucidate how frequently we can secure the veins with an artery via the first web space approach alone, using the Genial Viewer (a near-infrared light transmission imaging device). We observed the dorsal vein images of the bilateral big toes of 250 volunteers (male, n = 125; female, n = 125) using the device. We counted the total number of dorsal veins in the big toe, the veins that crossed the margin of the region equivalent to the half-big toenail flap, and the veins that branched off from the fibular side of the flap area. An unpaired Student's t-test was used for the statistical analyses. All of the dorsal big toes contained veins. The mean number of the veins was 2.3 (range, 1-4). Branched-off veins were observed in the area equivalent to the half-big toenail flap in 496 (99.2%) of the big toes, and the mean number of veins was 1.9 (range, 0-4). In four cases, the region contained no veins (unilaterally). Branched-off veins were observed in the first web space in 440 (88.0%) of the big toes, and the mean number of veins was 0.9 (range, 0-2). The present study indicated high consistency of the veins in partial toe-transfer flaps with a short vascular pedicle and the high possibility of harvesting a flap with only exposing the first web space. In addition, in most cases, the flap will include one or, at most, two veins in the first web space.

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

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

Reconstruction of thumb and finger nail defects by using hallux toenail flap transplantation with dorsal branch of proper plantar artery anastomosis

Objective To evaluate the method and clinical effect of hallux toenail flap transplantation with dorsal branch of proper plantar artery anastomosis in the reparation thumb and finger nail defects.Methods From January 2010 to October 2012,three cases with thumb nail defects and 9 cases with finger nail defects were repaired by the hallux toenail flap transplantation.The dorsal branch of proper plantar artery of toenail flap was anastomosed with proper palmar digital artery or dorsal branch of proper palmar digital artery; using suture,dermatoplasty and hallux fibular flap to repair the donor site of hallux.Results All 12 cases of grafted hallux toenail flaps survived.All patients revealed favorable functions and growth of nail,nine cases of the grafted hallux toenail appearance was smooth and outline were satisfied,two case of the grafted hallux toenail was not smooth,one case of the grafted hallux toenail was obvious contracture and scar hyperplasia around the suture after 4-14 months followed-up,there was no abrasion to break happened in the area of dermatoplasty and flap.Conclusion It is a smaller injury and reliably method that using hallux toenail flap transplantation with dorsal branch of proper plantar artery anastomosis to repair the thumb and finger nail defects. Key words: Hallux toenail flap; Proper plantar artery; Thumb; Finger; Nail bed

Repair of different types of nail bed defect by free toe nail flap

Objective To investigate the clinical application of free nail bed flap from the toe in the treatment of different types of nail bed defects of the finger.Methods Twelve cases of fingernail bed defects were treated with transplantation of free nail bed flap of various shapes from the toe based on the type and shape of nail bed defect.Donor site of the toe could be closed directly in 5 cases,while a fibular toe flap pedicled on the dorsal digital artery and skin graft was used to close the donor site wound in 7 cases.Results The 12 transferred toe nail bed flaps all survived,as well as the fibular toe llaps and skin grafts at the donor site.Patients were follow-up for 1 to 18 months,with an average of 7 months.Appearance of the reconstructed fingernails was satisfactory.Varying degrees of contracture of the nail were seen in 4 cases.Finger function was good.There was no obvious scar and blister formation at the donor site.Walking was not affected.Concclusion Transfer of free nail bed flap from the toe is an ideal method to t-eat different types of nail bed defects of the finger. Key words: Tissue transplantation; Microsurgery; Nail bed injuries

Repair of a degloving injury of the thumb with a combined dorsal great toenail flap and dorsalis pedis flap: a case report

Many methods for the repair of degloving injuries of the thumb have been reported, but none are entirely satisfactory. Herein, we report a method in which the injury is divided into the dorsal and palmar area for repair. A great toenail flap is used to repair the dorsal injury to restore the nail defect, and a dorsalis pedis flap is used to repair the palmar injury. The described technique provides good restoration of morphology and aesthetic outcome, good functional and sensory recovery, and is associated with minimal donor-site morbidity.

Clinical application of reconstructive surgical procedures of thumb

Objective To summarize the surgical methods and clinical efficacy of the thumb fullshaped reconstruction.Methods Fourteen cases with Ⅲ and Ⅳ degree thumb defect were underwent the thumb full-shaped reconstruction from March 2010 to May 2012.According to the region need,cutting the hallux toenail flap and second toe bone flap of the same vascular pedicle,and then the hallux toenail flaps wrapped second toe bone flap was transferred to reconstruction of thumb shape and function.Hallux toenail flap donor site was repaires with second toenail flap.Results Thumbs of 14 cases were all survived.Vasospasm were occurred in 2 cases at operation and were relieved by lidocaine dropped outside vascular and local fomentation by warm saline.The remaining 12 cases of thumb reconstruction survived successfully.Fourteen patients were followed up for 6-18 months(12 months on average).Except for 1 case of nail irregularity,the remaining reconstructive thumb recovered well.The appearance was the same as contralateral one.The flexion and extension function were recovered.The two-point discrimination of the finger pulps was ranged from 6mm to 8 mm.According to the trial standard of upper limb part of functional assessment of the Hand Surgery Branch of Chinese Medical Association,among the 14 cases,there were excellent in 7,good in 6,and fair in 1,with an excellent and good rate of 92.9％.Conclusion Hallux nail flap combined with second toe bone flap of the same vascular pedicle was transferred to repair and reconstruct thumb of appearance and function.Although the difficulty and risk of operation is large,after reconstruction the appearance and function of thumb is good.This technique is an ideal procedure and worthy of promotion. Key words: Thumb; Hallux nail flap; Second toe bone flap; Full-shaped reconstruction; Microsurgery

Donor site repair of great toe-nail flap in finger reconstruction surgery

struction surgery Objective To explore methods of donor repair of the great toe-nail flap in finger recon- Methods From December 1998 to December 2010, various kinds of flaps were used in 511 donor sites to repair the great toe-nail flaps, including： 32 dorsal pedal artery flaps; twenty-four first dorsal metatarsal artery flaps; twenty-one second dorsal metatarsal artery flaps; forteen anterior malleolar flaps; seventeen medial tarsal artery flaps; seventy-nine lateral tarsal artery flaps; one hundred and six plantar metatarsal flaps, seventy-nine flaps from second toe; fifteen flaps from mid/lower leg and 124 freed flaps. Results After postoperative 6 months to 11 years of follow-up, repaired donor sites of great toe-flaps all survived successfully, with ideal outlook and function. Conclusion There are many kinds of methods for donor site repair of the great toe-nail flap, and each kind of method has its own advantages and disad- vantages. Among these flaps, plantar pedal artery flap and free groin flap are amony the best ones. Key words: Great toe-nail flap ; Transplantation ; Finger ; Reconstruction ; Microsurgery