Reconstruction of complex nail matrix defect using the homodigital reverse fasciocutaneous flap

Reconstruction of complex and severe nail matrix defects with the exposure of bone, tendon or joint continues to be challenging for the surgeon. We present our experience using the homodigital reverse laterodorsal fasciocutaneous flap in the reconstruction of complex nail matrix defects. Six patients (7 fingers) of complex nail matrix defects with the exposure of bone, tendon or joint were treated with the homodigital reverse laterodorsal fasciocutaneous flap based on the dorsal branches of the proper digital artery. In this study, the composite tissue defect size ranged from 1.0 × 1.5 cm(2) to 1.3 × 2.5 cm(2). All 6 patients participated in follow-up. All flaps survived well, and no complications were found postoperatively. The mean size of the flaps was 1.4 × 2.4 cm(2) (range, 1.2 × 2.0–1.5 × 3.0 cm(2)); the mean follow-up period was 8 months (range, 4–15 months); patients’ average time to get back to their former jobs was 4.3 weeks (range, 3–6 weeks) postoperatively. All patients were satisfied with the appearance and functional outcomes of the fingers. The homodigital reverse laterodorsal fasciocutaneous flap based on the dorsal branches of the proper digital artery is an ideal surgical method to reconstruct the complex and severe nail matrix defect.