[Composite nail transfer by the traditional method]

We have retrospectively reviewed our experience in the treatment of traumatic loss of the whole nail complex.

Contraindications for our technique are cases suitable for microsurgical transfer and cases with a poorly vascularised recipient bed. Under local anaesthesia, we harvested the nail unit composed of the eponychiurn matrix, nail table, hyponychium and lateral folds. The transfer to the recipient finger was also performed under local anaesthesia. Post operative cryotherapy for 72 hours was combined with a prostaglandin E1 infusion (50 micrograms per day during 3 days). The functional result was assessed by the coin test and the cosmetic result by VAS (from 1 to, 10).

Eleven patients were operated on according to the technique between April 1995 and June 1997. Minimum follow-up was 6 months. Average follow-up was 13 months. There were 9 men and 2 women with a mean age of 31 years (range: 13-40). Among the 14 injured fingers, the index was involved 2 times, the middle finger 5 times, the ring finger 3 times and little finger 4 times. The aetiology was a burn in one case and direct trauma in the other 13. We obtained 11 good results; 2 nails with slight dystrophy and one failure secondary to an infection (the burn case). The coin test was good in 13 cases and the mean cosmetic VAS was 8/10.

Our technique is easy and well accepted by the patient. It gave 11 good results out of 14 cases. According to the literature, this method has fallen into disuse due to its unpredictable results. It seems to us that this technique has to be put into balance with microvascular transfer; a much more sophisticated operation and with a nail prosthesis which is not always well accepted and is very difficult to fix. A major prerequisite remains a well vascularised recipient bed. Cryotherapy in the post operative period decreases the metabolism and avoids ischaemia during the phase of revascularisation, and explains the quality of our results.