Clinical Examples: Nailbed Ablation and Skin Graft

The fingernail complex is ...complex. Local flaps are unavailable for resurfacing large nail bed defects, and regional or pedicled flaps are not justified in most situations. Fortunately, the dorsal cortical bone of the distal phalanx provides a well vascularized stable bed for a skin graft. These three cases illustrate the use of full thickness skin grafts for nailbed defects following nailbed ablation.
Click on each image for a larger picture


Case 1.
Biopsy proved superficial squamous cell carcinoma of the nail bed.
Highslide
Defect following en bloc resection of entire nail complex.
Highslide
Full thickness skin graft from proximal medial forearm. Everting horizontal mattress sutures maximize graft contact area.
Highslide

Highslide
Three months postop.
Highslide

Highslide

Highslide
Case 2.
Nuisance posttraumatic deformity.
Highslide
Defect following sterile and germinal matrix excision with periosteum, dorsal cortex exposed. This was resurfaced with a small full thickness skin graft from the proximal medial forearm (not shown).
Highslide
Three months postop.
Highslide

Highslide

Highslide
Case 3.
Nuisance posttraumatic nail deformity.
Highslide

Highslide

Highslide

Highslide
Video captures of excision and skin grafting of germinal matrix only. An eponychial splitting incision was used; an ellipse of skin graft was taken from the dorsolateral middle phalanx skin in continuity with this incision.
Highslide

Highslide

Highslide

Highslide

Highslide
Three weeks postop.
Highslide

Highslide

Highslide
Search for...
nailbed reconstruction
fingernail deformity
nailbed graft

Case Examples Index Page e-Hand home