Nail transfer: evolution of the reconstructive procedure

Reconstruction of a missing or deficient nail is an interesting and challenging undertaking for plastic surgeons, but little has been published concerning this topic. In the past 23 years, from 1973 to 1995, we performed 24 operations for nail reconstruction in 19 patients. A free nail graft was used in 14 operations, and a vascularized nail flap was used in 10. Vascularized nail flaps were divided into three categories: long-pedicle vascularized nail flaps (3 nails), vascularized nail flaps supplied by arterial inflow from the venous system (termed venous flaps, 3 nails), and short-pedicle vascularized nail flaps (4 nails). In only one case of free nail graft did the grafted nail necrose secondary to infection. The other 23 nails (13 free nail grafts, 10 vascularized nail flaps) survived completely, and good nail growth was obtained. With progress in plastic surgery, reconstructive procedures for nails have changed. In this paper, we will report the evolution of our reconstructive procedure and current strategy of nail reconstruction.