A Novel Single-Stage Pleated Nailbed Flap for Toe Macrodactyly Debulking

The authors describe a novel single-stage, nailbed-preserving debulking procedure for macrodactyly used in their unit. This simple technique preserves perfusion and venous drainage of the nailbed complex through a subperiosteal dissection and use of a dermal bridge by de-epithelialization of the proximal area, followed by folding the nailbed flap back onto itself in a pleated fashion. Four toes of 3 patients were treated with this technique, and all achieved a shorter, less bulky appearance with nail preservation at 2-year follow-up. The single-stage pleated nailbed flap is a simple and robust method for nail complex preservation in cases of macrodactyly debulking, with good cosmetic results and high patient satisfaction.