A Novel Single-Stage Pleated Nailbed Flap for Toe Macrodactyly Debulking.
Martin Van Carlen, Parisa Moori, Pundrique Sharma et al.
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Case in brief
The report describes a single-stage, nailbed-preserving debulking technique for toe macrodactyly, applied to four toes in three patients. The procedure used subperiosteal dissection and a de-epithelialized proximal dermal bridge to maintain perfusion and venous drainage, then folded the nailbed flap back on itself in a pleated fashion. At 2-year follow-up, all treated toes had a shorter, less bulky appearance with the nail preserved.
What made this case unusual
The technique preserves the nailbed complex during debulking by retaining a dermal bridge and folding the nailbed flap into pleats, rather than sacrificing the nail complex.
Diagnostic / clinical pearl
In toe macrodactyly debulking, subperiosteal dissection and a dermal bridge may help preserve nailbed perfusion and venous drainage while allowing the nailbed to be folded for a shorter, less bulky contour.