Does nerve repair influence the outcome of reconstruction of a digital nail defect using a free composite flap taken from the great toe?

Abstract

We describe reconstruction of a nail unit defect in the finger using a free composite flap taken from the great toe, comparing the outcome in patients in whom neurorrhaphy between the dorsal digital nerve of the great toe and the dorsal branch of the proper digital nerve of the injured finger was performed to those in which no nerve repair was made. From January 2002 to March 2009, 47 patients with traumatic fingernail defects were treated. Twenty-two patients before February 2005 had no nerve repair and subsequently 25 patients had nerve repair. The mean size of the germinal matrix and sterile matrix defects was 9 × 8 mm, and the mean size of the nail bed flaps was 9 × 9 mm. The mean length of the arteries used for the flap was 2.2 cm. Outcomes were rated. In the nerve repair group, full flap survival was achieved in 24 patients. At the mean follow-up period of 25 months, there were 12 excellent, seven very good, four good, and two fair results. In the comparison group without nerve repair, there were seven excellent, four very good, four good, five fair, and two poor results. Donor site morbidities were similar in both groups. The use of a free composite flap taken from the great toe is a useful technique for reconstructing nail unit defects in the finger. Innervated nail flap reconstructions tended to show better outcomes than those in which no nerve repair was performed. There is no difference in function or donor site between those in whom the nerve was repaired compared with those in whom it was not repaired.