Hard-palate mucosal graft in the management of severe pincer-nail deformity

A hard-palate mucosal graft was used to correct a severe pincer-nail deformity. In the technique described, an incision is made along the nail bed after the nail plate is pulled, and the nail-bed tissue flap is elevated at the layer above the digital bone. After the digital bone is shaved flat, a blunt dissection is made to the surrounding periungual tissue to spread the shrunken nail bed. When the nail-bed tissue is returned to its original position, the nail-bed defect occurs mainly at the distal site of the bed. Hard-palate mucosa containing periosteum is grafted onto the defect. Fifteen months after the operation, the deformity had not recurred on either side of the nail bed. The regrown nail plate was flat and straight and did not float. The palate donor site was left open, epithelialization occurred spontaneously in 5 weeks, and no symptoms or significant deformational changes were noted. These results suggest that hard-palate mucosal grafts are a valid choice for nail-bed repair in the treatment of patients with severe pincer-nail deformity.