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초록

Nail injuries are one of the most common injuries of the hand. Complete loss or posttraumatic deformity of the nail causes cosmetic as well as functional problems. Many reconstructive procedures including prosthesis, split thickness nailbed graft, vascularized free toe nail flap have been introduced, but there were few acceptable methods in case of partial loss of nailbed and pulp or hooknail deformity. In case of partial loss of nailbed and pulp, we used composite graft (nailbed and pulp) form great toe. The hooknail deformity is a complication of finger tip amputation. If there is loss of support of the distal nailbed over the distal phalanx, the nailbed may curve volarly. The nail will continue to curve after leaving the nailbed and can result in a tight, painful tip with inadequate padding as well as the cosmetically unpleasant clawlike nail. To correct the deformity, it is necessary to release the distal nailbed completely, return it to the normal position, and provide adequate support to maintain correction of the volarly deformed nail. In cases of hooknail deformity, we used composite graft(pulp) from great toe after elevation of nailbed-periosteal flap. This method had some advantages in these aspects (1) it can be performed under local anesthesia. (2) simple and one stage operation (3) minimal donor site morbidity (4) donor is identical to finger tip. In summary, composite graft technique could successfully performed in specific situations such as partial loss of nailbed and pulp or hooknail deformity.

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