Kỹ Thuật Thực Hành Trong Phẫu Thuật Ghép Vạt Da

292
Tips
The combination of a reverse digital artery fl ap and hemi pulp transfer is also practical
1. A skin defect exceeding the distal phalanx was present on the fi ngertip of the index fi nger, however the skin defect
on the middle fi nger was within the distal phalanx.
2. The index fi nger was reconstructed using a hemi pulp fl ap, and anastomosis was performed with the digital artery
of the toe to the digital artery of the fi nger and of the cutaneous veins with each other. The digital nerve of the toe
was sutured to the digital nerve of the fi nger.
The middle fi nger was reconstructed using a reverse fl ow digital arterial fl ap. A skin graft was done on the donor
area.


8 Reconstruction of Fingertip

293
Tissue Banking by Insertion in Subcutaneous Pocket (Level of Diffi culty: 1)
Information
For cases needing reconstruction using fl aps that cannot be reconstructed immediately, it is possible to temporarily
insert the injured tissue subcutaneously in the abdomen and carry out reconstruction some time later. Inserting the
damaged tissue can prevent progress of necrosis and infection, however the insertion period should be kept to within 1
or 2 weeks.


Tissue Banking by Insertion in Subcutaneous Pocket (Level of Diffi culty: 1)

294
Operation Procedures
Fig. 8.74 Procedure 1: After suffi ciently washing the damaged fi nger-
tip, the entire fi nger is inserted into the pocket created subcutaneously
in the abdomen under local anesthetic, and sutured in place
Fig. 8.75 Procedure 2: Appearance when removed after 2 weeks.
Infection of the fi ngertip has been restrained


8 Reconstruction of Fingertip

295
Fig. 8.76 Procedure 3: A hemi pulp fl ap is elevated/harvested from
both great toes. An artifi cial dermis is placed over the donor site and a
skin graft is performed 2 weeks later
Fig. 8.77 Procedure 4: A hemi pulp fl ap is harvested with a short ped-
icle containing the digital artery of the toe, the digital nerve of the toe
and cutaneous vein


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296
Fig. 8.78 Procedure 5: The index fi nger and middle fi nger are
reconstructed
a
b
Fig. 8.79 ( a , b ) Procedure 6: Appearance 6 months after reconstruction


8 Reconstruction of Fingertip

297
Fig. 8.80 Procedure 7: Appearance of the foot after harvesting of the
fl ap

Tissue Banking by Insertion in Subcutaneous Pocket (Level of Diffi culty: 1)

298
Ulnar Parametacarpal Flap (Level of Diffi culty: 3)
Information
Vascular pedicle There are several cutaneous branches that extend from the palmar digital artery of the little fi nger to
the lateral side of the palm, and it is possible to elevate the fl ap with any of the branches, however under normal cir-
cumstances the fl ap is elevated using the cutaneous branch to the ulnar MP joint of the little fi nger.
Size Created to a width that allows direct closure on the ulnar side of the palm. In adults this is normally 15–20 mm
Advantage Can cover from the area near the ulnar side of the palm to the tip of the little fi nger. It is possible to elevate
an island fl ap as a vascularized fl ap.
Disadvantage The area of coverage is comparatively small


8 Reconstruction of Fingertip

299
Operation Procedures
Fig. 8.81 Procedure 1: Case of an amputated little fi nger
Fig. 8.82 Procedure 2: The skin fl ap is designed along the border of
the palm and the dorsum of the hand


Ulnar Parametacarpal Flap (Level of Diffi culty: 3)

300
Fig. 8.84 Procedure 4: The subcutaneous pedicle is created while
remaining conscious of the branch from the palmar digital artery, with
suffi cient dissection of all other areas. This enables the fl ap to be easily
rotated. A drain tube is inserted in the donor area and the wound is
closed
Fig. 8.83 Procedure 3: An incision is made around the circumference
of the fl ap, and leaving the subcutaneous pedicle of the ulnar side of MP
joint of the little fi nger (10–15 mm diameter) in place, the fl ap is ele-
vated including the abductor digiti minimi muscle fascia


8 Reconstruction of Fingertip

301
© Springer Japan 2017
Y. Hirase, Practical Techniques in Flap Surgery, DOI 10.1007/978-4-431-56045-6_9
Toe Transfer
Basic Principles
1. Amputation level of thumb

2. Clinical Principles of Thumb Reconstruction

(a)  Nail bed level amputation (nail matrix intact)

Volar flap + Nail bed graft

(Refer to Chap. 10)

(b)  Distal phalanx amputation (including IP joint amputation)

Wrap-around flap (+ volar flap)

(Refer to Chap. 10)

(c)  Basal phalanx amputation (distal to MP joint)

Great toe transfer

Twisted wrap-around flap (TWA) flap

(d)  Metacarpal level amputation (loss of MP joint)

Second toe transfer

Pollicizatione.

(e)  Degloving injury

Twisted wrap-around flap (+ dorsal pedis flap)

(Refer to Chap. 4)
The difficulty level of each surgical procedure is shown subsequent to
the procedure title (e.g., Level of Difficulty: 2). The levels range from 1
to 5, with level 1 indicating a preliminary level and level 5 indicating a
very advanced level.
9

302
3. Clinical Principles of Finger Reconstruction

(a)  Nail bed level amputation (nail matrix intact)

(Refer to Chap. 10)

Split-thickness nail bed graft and digital artery flap (+ distal phalanx bone graft
from second toe)

Vascularized nail bed graft (with bone)

(b)  Nail matrix graft

Wrap-around flap (+ volar flap)

(Refer to Chap. 10)

Twisted wrap-around flap

(Refer to Chap. 10)

Second Toe Transfer

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303
Thumb Amputation at Basal Phalanx Level: Twisted Wrap-Around (TWA) Flap
(Level of Difficulty: 5)
Information
Vascular pedicle For the artery, either the first dorsal metatarsal artery or plantar metatarsal artery is used. One subcu-
taneous vein and one digital toe nerve are attached separately to both wrap-around flaps.
Size As far as possible, inclusion of skin from weight-bearing areas is avoided, using the skin from the dorsum of the
toe and first web space skin. Bone is harvested using lateral 1/3 of distal phalanx of great toe attached to flap.
Caution The artery for the two wrap-around flaps comes from the dorsal metatarsal artery or plantar metatarsal artery.
It is possible to dissect the vein up to the proximal position, and elevate the flap using one vein, but this can lead to
complicated twisting of the artery and the vein when combining the two flaps after transfer, and subsequent problems
with circulation. Therefore one subcutaneous vein is harvested for each flap.

Thumb Amputation at Basal Phalanx Level: Twisted Wrap-Around (TWA) Flap (Level of Difficulty: 5)

304
Operation Procedures
Fig. 9.1  Procedure 1: Replantation surgery on incomplete amputation
of thumb was unsuccessful, however tendon and bone remained intact.
Arthrodesis of IP joint conducted
a
Fig. 9.2  (a, b) Procedure 2: A WA (wrap-around) flap is designed
from both the great and second toes. The nail is included in the flap
harvested from the great toe. On the planter side of the toe, harvesting
of skin flaps from weight-bearing areas is avoided, with skin harvested
directly above the plantar digital artery/plantar digital nerve
Refer to Section of  “Extended Twisted Wrap-around (TWA) Flap” in
Chap. 4 and Section of “Fingernail Reconstruction: Twisted Wrap-
Around (TWA) Flap” in Chap. 10
9  Toe Transfer

305
Note  If the skin flap is harvested with excess fat still attached to the
first web space, fat can apply pressure to the blood vessels when two
flaps are combined, causing a vascular disturbance. The flaps are ele-
vated with as little fat attached as possible.
Fig. 9.3  Procedure 3: Bone is harvested in the nail flap with the lateral
1/3 of the distal phalanx of the great toe attached. The blood vessels/
nerves of the two skin flaps are dissected with as little fat attached as
possible
b
Fig. 9.2  (continued)
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306
Fig. 9.5  Procedure 5: The nail and bone within the flap is wired to the
distal phalanx of the recipient site, and after anastomosis of the dorsal
metatarsal artery with the radial artery distal to the snuff box, an addi-
tional anastomosis is performed between the plantar metatarsal artery
and the ulnar digital artery on the volar side
Fig. 9.4  Procedure 4: The dorsal metatarsal artery and the plantar
metatarsal artery are used for the arterial pedicle
9  Toe Transfer

307
a
Fig. 9.6  (a, b) Procedure 6: Anastomosis of the subcutaneous vein is
performed separately for each flap. The digital toe nerve included in
each of the flaps is sutured to the digital nerve on both sides. Appearance
immediately after surgery
b
Thumb Amputation at Basal Phalanx Level: Twisted Wrap-Around (TWA) Flap (Level of Difficulty: 5)

308
Tips
Combine with the dorsal pedis flap for a larger TWA flap.
It is possible to cover an even larger area if creating an extended TWA flap that combines the TWA flap with the
dorsal pedis flap.
Photo shows the before and after pictures of a whole thumb reconstruction using an extended TWA flap.
Refer to Section of  “Degloving injury/Extended twisted wrap-around (TWA) flap” in Chap. 4
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309
Tips
If reconstructing the donor site area in one stage, elevation of the reverse vascular pedicled extensor digitorum
brevis (EDB) muscle flap and conducting a skin graft is also an option.
As a simple dressing procedure of the donor site area, an artificial dermis can be temporarily applied and then a skin
graft conducted onto the granulation tissue. However, if wanting to complete the reconstruction in one stage, there is
the option of extending the skin incision to the dorsal pedis, elevating the reverse vascular pedicled EDB muscle flap,
covering the exposed bone of the great toe and then conducting a skin graft there. The communicating branch between
the dorsal pedis artery and the plantar artery system must remain intact in order to carry out this procedure.

Thumb Amputation at Basal Phalanx Level: Twisted Wrap-Around (TWA) Flap (Level of Difficulty: 5)

310
Information
Neuro vascular pedicle Arteries used are first dorsal metatarsal artery and plantar metatarsal artery. For the nerves,
the bilateral digital toe nerve and deep peroneal nerve are used. For the veins, two cutaneous veins are used. The vas-
cular pedicle does not need to be the full length of the dorsal pedis artery.
Indication For an amputation at the IP joint level of the thumb, it is possible to conduct a fusion of the IP joint using
a partial toe transfer with the distal phalanx. But in the case of a basal phalanx amputation close to the MP joint, the
first choice should be a whole great toe transfer, with a reconstruction of the IP joint. There is also the method of con-
ducting a wrap-around flap of the iliac bone graft, but wherever possible, the author chooses to conduct a whole great
toe transfer to avoid having to conduct a large non-vascularized bone graft.

Thumb Amputation at Basal Phalanx Level: Great Toe Transfer (Level of Difficulty: 4)
9  Toe Transfer

311
Operation Procedures
Fig. 9.8  Procedure 2: The donor site skin is cut in a zigzag pattern. The
method of dissecting the neurovascular pedicle is the same as for the
wrap-around flap
Fig. 9.7  Procedure 1: Amputation at basal phalanx of thumb. Recipient
site is cut open with a banana splitting fashion
Note  For more details see Tips.
Refer to Section of  “Nail reconstruction/Distal phalanx amputation
of thumb: Wrap-around flap” in Chap. 10
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312
Fig. 9.9  Procedure 3: Because the vascular anastomosis is performed
in the distal region of the snuff box, the length of the arterial pedicle can
be 3–4 cm shorter. The bilateral digital toe nerve is included when har-
vesting, as well as the deep peroneal nerve and two subcutaneous veins,
where necessary
Fig. 9.10  Procedure 4: The bone is wired in place and an interlacing
suture of the flexor tendon conducted proximal to the A1 pulley. A mat-
tress suture is conducted on the extensor tendon in dorsum of hand. The
bilateral digital toe nerve and the digital nerve are sutured, and if pos-
sible, the deep peroneal nerve is sutured to the dorsal digital nerve (dor-
sal branch of the radial nerve). Anastomosis is performed between the
dorsal metatarsal artery and the dorsal branch of the radial artery distal
to the snuff box, and between the plantar metatarsal artery and the ulnar
digital artery on the volar side of the thumb. Anastomosis is performed
of the two cutaneous veins
9  Toe Transfer

313
Fig. 9.11  Procedure 5: Skin suture is conducted in a zigzag pattern.
The flap of the donor site is sutured closed so that sufficient fat is aggre-
gated in the weight bearing region of plantar area of the MP joint
Fig. 9.12  Procedure 6: If vascularization is stable, hand therapy can be
commenced 1–2 weeks after transplant. Because an interlacing suture is
used for the tendon, it is possible to start mild active exercise from the
commencement of hand therapy
Note  If it is not possible to close the donor site as is, either apply an
artificial dermis and conduct a secondary skin graft, or cover the bone
surface with a reverse vascular EDB ­muscle flap and conduct a skin
graft.
Refer to Tips in the Section of  “Thumb Amputation at Basal Phalanx
Level: Twisted Wrap-Around (TWA) Flap”
Note  When conducting transfer of the whole great toe, it first appears
a little large, but due to atrophying, after about 6 months, the feeling of
discomfort about the size difference tends to disappear.
Thumb Amputation at Basal Phalanx Level: Great Toe Transfer (Level of Difficulty: 4)

314
Tips
Use the banana splitting method.
The recipient site is cut open in the shape of the cross. This kind of cut enables the junction of the reconstructed
thumb to be created in a zigzag pattern, preventing edema or scar contracture from occurring, and realizing a highly
aesthetic reconstruction.

9  Toe Transfer

315
Tips
Which is safer, the short pedicle or long pedicle?
In conducting a toe transfer, from a harvesting level of the vascular pedicle, there are three locations: the toe artery,
the dorsal metatarsal artery (if this is lost then plantar artery) and the dorsal pedis artery. Because of the greater diam-
eter of the artery when harvesting a long pedicle extending to the dorsal pedis artery, it may seem safer, however there
is actually a large risk involved. For the following reasons a short pedicle is preferred.
1. Long harvested blood vessels are in a denervated state, and it can be assumed that there is no pump action in the
vascular walls. This means that it simply becomes a conduit through which blood flows, and the longer the vascular
pedicle the stronger the blood circulation required.
2. Torsion tends to occur with long vascular pedicles.
3. For the thumb reconstruction, by using the distal region of the snuff box for arterial anastomosis rather than the
snuff box itself, it is possible to shorten the length of the vascular pedicle required by about 3–4 cm. Using this
method, it is not necessary to use a long vascular pedicle extending to the dorsal pedis artery, and a length extending
to the level of the dorsal metatarsal artery or digital toe artery is sufficient.

Thumb Amputation at Basal Phalanx Level: Great Toe Transfer (Level of Difficulty: 4)

316
Thumb Amputation at Metacarpal Level: Second Toe Transfer (Level of Difficulty: 4)
Information
Neurovascular pedicle First dorsal metatarsal artery (or plantar metatarsal artery), bilateral digital toe nerve
Advantage Possible to reconstruct the function of MP joint of thumb
Disadvantage Too slim as thumb. Extension lag of IP joint.

9  Toe Transfer

317
Operation Procedures
Fig. 9.13  Procedure 1: Case of thumb amputation case at metacarpal
level. Amputation stump is covered by abdominal skin flap
Fig. 9.14  Procedure 2: Second toe harvested at metatarsal level with
plantar metatarsal artery, bilateral digital toe nerve, dorsal metatarsal
artery, subcutaneous vein, flexor tendon and extensor tendon attached
Thumb Amputation at Metacarpal Level: Second Toe Transfer (Level of Difficulty: 4)

318
Fig. 9.15  Procedure 3: Bone is wired in place in opposing position at
metacarpal level. Interlacing suture is conducted of flexor tendon proxi-
mal to the A1 pulley, and mattress suture is conducted for extensor
tendon
9  Toe Transfer

319
Tips
When closing the first web space, pay attention not to overlap the great toe with the third toe, while avoiding
leaving it too open.
If the metatarsal isn’t removed to the proximal position then the web space will be too large. The width of the foot
will not change even if the entire second toe is removed, so there will be no problem with fitting of shoes.

Thumb Amputation at Metacarpal Level: Second Toe Transfer (Level of Difficulty: 4)

320
Pollicization and Free Abdominal Perforator Flap (Level of Difficulty: 5)
Information
Neurovascular pedicle Digital artery, digital nerve, subcutaneous vein
Indication Pollicization using index finger

9  Toe Transfer

321
Operation Procedures
Fig. 9.16  Procedure 1: Thumb and hypothenar region lost due to avul-
sion injury. Second metacarpal bone also lost. The index finger was
transferred as island flap by dissection of neurovascular pedicle and
subcutaneous vein
Fig. 9.17  Procedure 2: Basal phalanx bone is wired to carpal bones.
(In cases where the CM joint of the thumb is intact, the second metacar-
pal bone is fixed to the first metacarpal bone and the CM joint of thumb
is retained.) Flexor and extensor tendons were shortened and
re-sutured
Pollicization and Free Abdominal Perforator Flap (Level of Difficulty: 5)

322
Fig. 9.18  Procedure 3: Thinning of fatty tissue was performed after
elevation of the abdominal perforator flap
9  Toe Transfer

323
Fig. 9.19  (a, b) Procedure 4: The reconstructed thumb (transferred
index finger) was wrapped with the free abdominal perforator flap and
end-­to-­side anastomosis was conducted of the vascular pedicle of the
flap to the radial artery
a
b
Pollicization and Free Abdominal Perforator Flap (Level of Difficulty: 5)

324
Information
Neurovascular pedicle Digital toe artery (or dorsal metatarsal artery) anastomosed to digital artery of finger (or common
digital artery). Venous drainage made between subcutaneous veins. Digital toe nerve sutured to digital nerve of finger.
Indication Case of amputation proximal to PIP joint.
Advantage Possible to reconstruct the PIP joint.
Disadvantage The reconstructed PIP joint is located more distal than the original position. Extension lag tends to
occur at PIP joint. Reconstructed nail is short and finger is thicker at fingertip.

Finger Reconstruction (Basal Phalanx Amputation Case): Second Toe Transfer
(Level of Difficulty: 4)
9  Toe Transfer

325
Operation Procedures
Fig. 9.20  Procedure 1: Index finger amputated at basal phalanx level
and PIP joint is lost
Fig. 9.21  Procedure 2: Second toe harvested at MP joint level.
Harvested with dorsal metatarsal artery, plantar metatarsal artery, sub-
cutaneous vein, bilateral digital toe nerve and flexor tendon/extensor
tendon attached
Note  Defatting is conducted wherever possible during harvesting.
Finger Reconstruction (Basal Phalanx Amputation Case): Second Toe Transfer (Level of Difficulty: 4)

326
Fig. 9.22  Procedure 3: After wiring bone in place, interlacing suture
conducted of flexor tendon proximally to the A1 pulley. Dorsal metatar-
sal artery anastomosed to proximal end of digital artery and bilateral
digital nerve sutured to digital toe nerve. Full thickness skin graft con-
ducted onto skin defect area
Fig. 9.23  Procedure 4: After conducting mattress suture of extensor
tendon, two subcutaneous veins anastomosed
9  Toe Transfer

327
Fig. 9.24  Procedure 5: After 2 or 3 months have passed since the toe
transfer, it is possible to conduct defatting to make it thinner, but in
most cases the shape settles down naturally after about 6 months
Finger Construction (Basal Phalanx Amputation Case): Second Toe Transfer (Level of Difficulty: 4)

328
Tips
The unavoidable extension lag is a disadvantage inherent to this method.
The disadvantage of a PIP joint reconstruction using the second toe is that it is unavoidable that the reconstructed
joint be located distal to its original location, which results in an extension lag.

9  Toe Transfer

329
Metacarpal Hand: Double Toe Transfer (Level of Difficulty: 4)
Information
Neurovascular pedicle Digital toe artery (or dorsal metatarsal artery) anastomosed to digital artery of finger (or com-
mon digital artery). Venous drainage made between subcutaneous veins. Digital toe nerve sutured to digital nerve of
finger.
Indication Case of amputation at metacarpal level.
Advantage Possible to reconstruct the MP joint.
Disadvantage Extension lag tends to occur at PIP joint. Reconstructed nail is short and leaves cosmetic problems.

Metacarpal Hand: Double Toe Transfer (Level of Difficulty: 4)

330
Operation Procedures
Fig. 9.25  Procedure 1: Amputation at a metacarpal level from the
index finger to the fifth finger. Whole hand covered by a pedicled
abdominal flap
Fig. 9.26  Procedure 2: Second toe amputated proximal to MP joint,
harvested with short vascular pedicle
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331
Fig. 9.28  Procedure 4: Two months later, the second toe on opposite
foot harvested and toe transfer conducted to position of fourth metacar-
pal bone
Fig. 9.27  Procedure 3: Bone fixed in place at position of middle finger
and tendon suture, arterial and venous anastomosis and neurorrhaphy
conducted
Metacarpal Hand: Double Toe Transfer (Level of Difficulty: 4)

332
Fig. 9.29  Procedure 5: Final image. Although cosmetic problems
remain, from a functional point of view, there is considerable improve-
ment in the ability to pinch/grasp
Fig. 9.30  Procedure 6: Appearance of the feet. No effect on ability to
walk long distances
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333
© Springer Japan 2017
Y. Hirase, Practical Techniques in Flap Surgery, DOI 10.1007/978-4-431-56045-6_10
Nail Reconstruction
Basic Principles
1. Clinical Principles of Thumb Reconstruction
• Nail bed level amputation (nail matrix intact)
–– Volar flap + nail bed graft
• Distal phalanx amputation (Including IP joint amputation)
–– Wrap-around flap (+ volar flap)
• Basal phalanx amputation (distal to MP joint) Refer to Chap. 9
–– Great toe transfer
–– Twisted wrap-around flap (TWA) flap
• Metacarpal level amputation (loss of MP joint)
–– Second toe transfer
–– Pollicization
• Degloving injury
Twisted wrap-around flap (+ dorsal pedis flap) Refer to Chap. 4
2. Clinical Principles of Finger Reconstruction
• Nail bed level amputation (nail matrix intact)
–– Split-thickness nail bed graft and digital artery flap (distal phalanx bone graft from
second toe)
–– Vascularized nail bed graft (with bone)
• Nail matrix graft
–– Wrap-around flap (+ volar flap)
–– Twisted wrap-around flap
–– Second toe transfer
Selectable Flaps and Surgical Procedures
Spilt-thickness nail bed graft and digital arterial flap • Vascularized nail bed graft •
Wrap-­around flap • Digital arterial flap + partial toe transfer • Twisted wrap-around flap •
Venous nail graft • Toe transfer
The difficulty level of each surgical procedure is shown subsequent to
the procedure title (e.g., Level of Difficulty: 2). The levels range from 1
to 5, with level 1 indicating a preliminary level and level 5 indicating a
very advanced level.
10

334
10  Nail Reconstruction

335
Split-Thickness Nail Bed Graft (Level of Difficulty: 1)
Information
Caution Start harvest from great toe, harvesting from center to the surrounding area so that a normal nail bed is
retained. To avoid nail deformity, it is necessary to harvest from the toe tip. Harvest a thick split-thickness skin
graft, making sure that it doesn’t become too thin. In the case that a full-thickness nail bed is required, harvest
from the paronychium in accordance with the surgery method for ingrown toenails.

Split-Thickness Nail Bed Graft (Level of Difficulty: 1)

336
Operation Procedures
Fig. 10.1  Procedure 1: Thumb with nail bed defect
Note  Harvesting of the nail bed must be conducted from the center. If
harvested from the toe tip the nail will not regenerate, causing it to
become deformed.
Fig. 10.2  Procedure 2: Leaving the bilateral paronychium intact,
the center of the nail is cut and reflected. The required size nail bed
is designed from the center of the donor nail bed
10  Nail Reconstruction

337
Fig. 10.4  Procedure 4: The reflected nail is returned to its original
position and bandaged. This can be left as it is for 1 week. Shoes may
be worn from the following day
Fig. 10.3  Procedure 3: The nail bed is split using a No. 11 blade scal-
pel. It is possible to harvest a slightly thick section if the nail bed of the
donor site is intact on all sides, and as long as the periosteum is not
exposed
Split-Thickness Nail Bed Graft (Level of Difficulty: 1)

338
Fig. 10.5  Procedure 5: Nail bed is sutured to surrounding area using
fine absorbable suture thread
Fig. 10.6  Procedure 6: A tie-over bolster dressing is applied using a
cotton ball
10  Nail Reconstruction

339
Tips
Once the nail bed takes, a dry crust gradually forms, which is replaced by a normal nail
The transplanted nail bed forms a dry crust as the nail grows, that eventually peels off and is replaced by a normal
nail.

Split-Thickness Nail Bed Graft (Level of Difficulty: 1)

340
Split-Thickness Nail Bed Graft and Digital Arterial Flap (Graft-on Flap Method)
(Level of Difficulty: 3)
Information
The most effective finger flap for combining with a nail bed graft in the case of a thumb, is a volar advancement flap,
and in the case of a finger is either an oblique triangular flap or a reverse vascular pedicled digital arterial flap

10  Nail Reconstruction