A novel single-stage pleated nailbed flap for toe macrodactyly debulking

We describe a novel technique for a single stage nailbed preserving debulking procedure for macrodactyly used in our unit. This simple technique preserves the perfusion and venous drainage of the nailbed complex by a subperiosteal dissection and the use of a dermal bridge by de-epithelialisation of the proximal area and subsequently folding the nailbed flap back onto itself in a pleated fashion. Four toes in three patients were treated with this technique and all achieved a shorter and less bulky appearance with nail preservation at a 2 year follow up. We believe that the single stage pleated nailbed flap is a simple and robust method of nail complex preservation in cases of macrodactyly debulking, which gives good cosmetic results and high patient satisfaction.