Dorsal Digital Artery Anastomotic Toenail Transplantation For Reconstruction Of Thumb Or Finger Nail Defect

Objective : To investigate the clinical effects of Dorsal digital artery anastomotic Toenail Transplantation for Reconstruction of Thumb or Finger Nail Defect.Methods : From Jan, 2010 to Jun, 2014, in Ruihua Affiliated Hospital of Soochow University. we carried out 7 cases of Dorsal digital artery anastomotic geret Toenail Transplantation to reconstruction thumb nail defect and 8 cases of Dorsal digital artery anastomotic second digit of foot toenail transplantation to repair nail defect of 2-4finger. And skin grafting or pedicle flap prosthesis is carried out at the donor site of the foot.Results:The wound healing of the patients were all primary healing, and all of the7 transplanted thumb nails and 8 second digit of foot nails were all successful. There were one cases that had delayed union in the donor site of foot, and the wound healed after change of dressing. We followed up 15 patients for 5 ~ 24 months and the average of follow-up time was 11 months. The patients we followed up were satisfied with the appearance of their reconstructed fingers. The replaced thumb nails of the patients who had their thumb nails reconstructed with their toenails were as good as normal nails, while those who had 2-4 nails replaced by the second digit of foot had smaller nails than normal ones. The nails grew well with good touch sensation, and they could assist the finger pulp to do some action such as grasping, pinching, or picking up a needle. The flexion of interphalangeal joint of the patients with repaired thumbs could reach 50~90° with an average of 65°. And the distal interphalangeal joint flextion of the patients with repaired 2-4 fingers reached 30~70° with an average of 50°. 0ne of the 8 donors for skin grafting have linear cicatricial contracture in feet. The contracture was relieved after a second surgery of cicatricle resection, and the texture of other skin grafting area was good with loose and soft skin. The texture of skin flap in 7 cases of pedicle skin flap prosthesis were good,without obvious fat and clumsy appearance, and healing of the related skin grafting area was satisfying. Repair of nail after results according to Zook [ 14] of new nails evaluation criteria, 7 cases of application of toenail repair of thumb have reached the quality standard,8 cases of application of the second toenail repair 2-4 fingers to reach a good standard,overall excellent and good rate was 100%.Conclusions : Dorsal digital artery anastomotic Toenail Transplantation for reconstruction thumb or second digit of foot finger nail defect can notably repair the appearance of the fingers and also rebuild the functions of nails and reduce the damage of the donor site of foot.