Clinical application of free hallux nail flap combined with iliac bone graft for reconstruction of distal finger defects

Distal finger defects (DFDs) are common hand injuries that impair both appearance and fine motor function. Because these defects often involve the nail bed, phalanx, and soft tissue, reconstruction remains challenging. This study evaluated the clinical outcomes of Free Hallux Nail Flap combined with Iliac Bone Graft (FHNF) for DFD. We retrospectively reviewed patients with DFD treated with FHNF at Beijing Jishuitan Hospital Guizhou Hospital between January 2020 and December 2023. Pain was assessed using the Visual Analog Scale (VAS), upper limb function using the Disabilities of the Arm, Shoulder and Hand (DASH) score, donor-site foot function using the American Orthopaedic Foot and Ankle Society (AOFAS) score, blood supply using skin temperature, capillary refill time (CRT), and laser Doppler flowmetry, and sensory recovery using the 2-point discrimination (2PD) test. Patient satisfaction was assessed at 12 months by telephone follow-up using a 5-point Likert scale. Twenty-two patients were included, with a minimum follow-up of 12 months. All incisions healed, with a median healing time of 24.50 days (Q1, Q3: 22.00, 29.00), and no flap necrosis or no documented bone nonunion was identified during follow-up. The reconstructed digit length ratio was 97.53% (Q1, Q3: 93.45%, 98.60%), and the total active motion recovery ratio improved from 58.41% at 1 month to 87.43% at 3 months. The mean static two-point discrimination value improved from 15.50 ± 3.60 mm at 1 month to 8.36 ± 1.50 mm at 3 months. At 3 months, donor-site AOFAS outcomes were excellent or good in all patients. At 12 months, 20 patients (90.91%) were very satisfied and 2 (9.09%) were satisfied. FHNF is feasible for selected complex distal finger defects, but further comparative studies are needed.