Thin Split-Thickness Toe Nail-Bed Grafts for Nail Bed Defects in Subungal Exostosis: Two Cases Report

In Suk Oh; Chang Hee Kim; Jong-Sun Choi; Sang Hyeong Lee

doi:10.5292/jkbjts.2012.18.2.83

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Oh, Kim, Choi, and Lee: Thin Split-Thickness Toe Nail-Bed Grafts for Nail Bed Defects in Subungal Exostosis: Two Cases Report

Case Report

The Journal of the Korean Bone and Joint Tumor Society

The Journal of the Korean Bone and Joint Tumor Society 2012; 18(2): 83-88.

Published online: 21 December 2012

DOI: https://doi.org/10.5292/jkbjts.2012.18.2.83

Thin Split-Thickness Toe Nail-Bed Grafts for Nail Bed Defects in Subungal Exostosis: Two Cases Report

In Suk Oh^†, Chang Hee Kim, Jong-Sun Choi^*, Sang Hyeong Lee

Department of Orthopaedic Surgery, Dongguk University College of Medicine, Seongnam, Korea.

^*Department of Pathology, Dongguk University College of Medicine, Seongnam, Korea.

^†Department of Orthopedic Surgery, Armed Forces Capital Hospital, Seongnam, Korea.

Correspondence to: Sang Hyeong Lee. Departments of Orthopaedic Surgery, Dongguk University College of Medicine, 814, Siksa-dong, Ilsandong-gu, Goyang 410-773, Korea. TEL: +82-31-961-7296, FAX: +82-31-961-7290, drlsh@hanmail.net

Received 18 October 2012 Revised 21 November 2012 Accepted 22 November 2012

(open-access):

"This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited."

Abstract

We reviewed the clinical features of 2 patients who underwent surgery for subungal exostosis, focusing on postoperative deformity of the nail. The lesion destroyed the nail bed and was excised with a direct approach. then thin split-thickness sterile matrix graft was done after excision of the tumor because the defect of the nail bed was large. Good postoperative appearance of the nail was obtained by thin split-thickness sterile matrix graft. The use of thin split-thickness sterile matrix graft for the replacement of a nail bed defect can regain a smooth, adherent, and normal-looking nail and avoid donor-site morbidity. Thin split-thickness toe-nail bed graft is a good choice for the prevention of postoperative deformity.

Keywords: subungal exostosis, postoperative deformity, nail bed graft

Figures and Tables

Figure 1

A 14 year old male patient had subungal exostosis of great toe with ulceration of medial border of the nail and elevation the nail plate.

Figure 2

Preoperative radiograph showed a bony excrescence arising from the distal phalanx.

Figure 3

The tumor was approached directly from its top (After excision of the tumor).

Figure 4

Thin split-thickness nail bed graft was done to the defect. The black arrows show donor site and the yellow arrow shows recipient site.

Figure 5

Pathologic features of Case 1. (A) A cartilaginous cap overlies the underlying bone of the stalk (Hematoxylin & Eosin, ×40).

Figure 6

Seven months postoperatively, postoperative clinical photo showed improvement of nail deformity.

Figure 7

Postoperative radiograph showed no recurrence of the tumor.

Figure 8

A 10 year old male patient had subungal exostosis of great toe with severe nail bed destruction and onycholysis.

Figure 9

Preoperative radiograph showed a bony excrescence arising from the distal phalanx.

Figure 10

Pathologic features of case 2. The maturing chondrocytes in osteochondroma simulate endochondral ossification in the growth plate at the junction between the cartilaginous cap and stalk (Hematoxylin & Eosin, ×100).

Figure 11

Seven months postoperatively, postoperative clinical photo showed improvement of nail deformity.

Figure 12

Postoperative radiograph showed no recurrence of the tumor.

References

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