Microsurgical toe-to-finger transfer of the nail system: long-term outcomes

Abstract

Background: Reconstruction of the nail unit is often a neglected entity with few reports in the literature addressing the technique of its repair. The reconstruction is done with either non-vascularized nail grafts or vascularized free nail transfers, which have the benefit of transferring the germinal matrix which allows for proper nail growth. The nail is a dynamic structure that grows and changes in shape. Long-term follow-up is a requirement to determine the success of the reconstruction. Methods: We present eleven patients with total nail unit loss who underwent microsurgical total nail unit transfer. Six objective criteria were used to assess nail growth: Eponychial and paronychial retraction, speed of nail growth, nail orientation, adhesion to the nail bed, and the presence of nail fracture. Results ranged from “excellent” to “poor” according to the proposed score. Results: The mean follow-up time was 16.5 months. We had no cases of total or partial flap loss. No acute complications were encountered. The short pedicle technique was used in nine of the cases while the long pedicle technique in only two cases. Six patients had “excellent” results, four reported a “good” result, and only one patient had a “fair” result. Conclusions: Microsurgical toe-to-finger nail unit transfer is a reliable option for nail reconstruction when total nail loss is present. It holds the advantage of transferring all the components of the nail system including the germinal matrix and the cutaneous folds, which allows proper nail growth and an acceptable cosmetic outcome. Level of evidence: Level IV, therapeutic study. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.