An improvement in dorsal reverse adipofascial flap for fingertip reconstruction: nail matrix preservation.

Dorsal reverse adipofascial flap (DRAF) is one of the most reliable choices for reconstruction of fingertip amputations. A drawback of this method is matrixectomy, which is routinely performed in distal phalangeal amputations, even when the germinal matrix and some nail bed is intact. However, the nail is important for both functional and esthetic reasons and should not be killed. We described a new approach to DRAF, in selected cases, for preserving the nail. As a result, we obtained useful and esthetic fingertip with a nail unit.