Application of the palmar pocket method for total nail reconstruction without vascular anastomoses

We present a case of a nail defect, which was reconstructed by free composite nail combined with the palmar pocket method without vascular anastomoses. A 40-year-old man lost his nail of the right middle finger by trauma 1 year ago. A total nail composite graft, composed of germinal and sterile matrices, and proximal nail fold, from which the nail plate was removed, was harvested from the ipsilateral first toe and was grafted on the right middle fingertip. The grafted nail was inserted into the palmar subcutaneous pocket. Fourteen days after the first operation, the grafted part was removed from the pocket, and active bleeding was noted on the sterile matrix. Seven months after the second surgery, the nail had grown and had an almost normal appearance. There was no conspicuous scar at either the recipient or the donor site.