Arch Hand Microsurg.  2021 Jun;26(2):125-130. 10.12790/ahm.21.0085.

Simultaneous Volar Pulp and Nail Bed Reconstruction with the Second Toe Onychocutaneous Free Flap

  • 1Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Korea


Fingertip injury is one of the most common hand injuries. Although several types of advancement and cross-finger flaps exist, they would not be essential for nail bed defects. The authors present a simultaneous volar pulp and nail bed reconstructive technique that uses a second toe onychocutaneous free flap. Four patients without amputees underwent fingertip amputation reconstruction between 2011 and 2019. After thorough debridement, the defect size was estimated, and the digital arteries, nerves, and veins of the recipient were evaluated. The flap, composed of pulp tissue and nail bed, was harvested with continuity from the second toe. Additional split-thickness skin grafts were performed in two cases. All flaps survived without considerable complications. We evaluated the scar and contour, and nail growth was reported over Zook’s criteria grade B. The second toe onychocutaneous free flap provides a reliable option for fingertip defects that involve pulp tissue and nail bed without further amputation.


Fingertip; Nail bed; Free flap
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