Nail bed repair and reconstruction by reverse dermal grafts

Repair of traumatized nail beds and reconstructive procedures for nail deformations often lead to less than satisfactory results. This series of 19 patients had reverse dermal grafts applied either because of acute traumatic nail bed avulsion (nine patients) or for secondary reconstruction of a scarred nail bed with nail deformity (10 patients). Excellent results with nearly normal nail cosmesis were obtained in seven of nine primary nail bed repairs, whereas seven of 10 secondary reconstruction procedures ultimately had poor results. We conclude that the technique of reconstituting a nail bed with a reverse dermal graft for acute nail bed avulsion can lead to predictably satisfactory results.