Clinical Examples: Nailbed Ablation and Skin Graft
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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 |
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Case
1.
Biopsy proved superficial squamous cell carcinoma of
the nail bed. |
| Defect following en bloc resection of entire nail complex. |
| Full thickness
skin graft from proximal medial forearm. Everting
horizontal mattress sutures maximize graft contact
area. |
| Three months
postop. |
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Case 2.
Nuisance posttraumatic deformity. |
| 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). |
| Three months
postop. |
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Case 3.
Nuisance posttraumatic nail deformity. |
| 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. |
| Three weeks
postop. |
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