J Korean Bone Joint Tumor Soc.  2012 Dec;18(2):83-88. 10.5292/jkbjts.2012.18.2.83.

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

• Oh IS
• Kim CH
• Choi JS
• Lee SH

• KMID: 1431675
• DOI: http://doi.org/10.5292/jkbjts.2012.18.2.83

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.

Keyword

subungal exostosis; postoperative deformity; nail bed graft

MeSH Terms

Congenital Abnormalities
Exostoses
Humans
Nails
Toes
Transplants

Figure

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  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.

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  Figure 2 Preoperative radiograph showed a bony excrescence arising from the distal phalanx.

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  Figure 3 The tumor was approached directly from its top (After excision of the tumor).

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  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.

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  Figure 5 Pathologic features of Case 1. (A) A cartilaginous cap overlies the underlying bone of the stalk (Hematoxylin & Eosin, ×40).

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  Figure 6 Seven months postoperatively, postoperative clinical photo showed improvement of nail deformity.

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  Figure 7 Postoperative radiograph showed no recurrence of the tumor.

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  Figure 8 A 10 year old male patient had subungal exostosis of great toe with severe nail bed destruction and onycholysis.

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  Figure 9 Preoperative radiograph showed a bony excrescence arising from the distal phalanx.

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  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).

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  Figure 11 Seven months postoperatively, postoperative clinical photo showed improvement of nail deformity.

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  Figure 12 Postoperative radiograph showed no recurrence of the tumor.

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