The reconstruction of a claw nail by combining a reverse digital artery island flap with a free bone graft

The authors report two cases of a claw nail, an anomaly difficult to treat, which were repaired by combining a reverse digital artery island flap with a free bone graft. In one case a separate thickness of the nail bed was grafted at the distal end in an attempt to elongate the nail bed. After approximately two years, from 40 to 50% of the grafted bone had been absorbed in both patients, but the nail plates have maintained a fine shape without the return of the deformity. In both patients, sensory recovery in the transplanted skin flap, which had not been innervated, was very good. In reconstructing a claw nail, the most important consideration is how to keep the nail bed extended while keeping the finger tip free of tension. For this, a reverse digital artery island flap combined with a free bone graft was found to be ideal. Because disfigurement caused by a claw, nail is most conspicuous, the suthors feel that elongation of the nail bed should be the aim of the surgery for a better postoperative appearance.