Definition & Overview

A reconstruction of nail bed with graft is a surgical procedure performed when the nail bed has been severely damaged. The goal of the procedure is to restore its appearance and function. Damage to the nail bed usually occurs when the fingertip or toenail becomes injured, such as when they get caught in a door or crushed under a heavy object. Such injuries may damage the distal phalanx, the pulp or padding, the tendons, and the nerve endings.

Who Should Undergo and Expected Results

The procedure is for those who suffer from serious injuries to the extremities that result in serious damage to the nail bed.

The goal of treatment is to restore the normal anatomy of the nail bed and the structures that surround it. A reconstruction often becomes necessary if the entire nail bed, or a part of it is missing or can no longer be repaired. In some cases, the reconstruction involves a grafting procedure, or when a flap of tissue is taken from a healthy fingertip to replace the lost tissue in the injured fingertip to prevent finger deformities.

In most nail bed reconstructions with graft, results are quite satisfactory. Soft-tissue healing, as well as future nail growth, is generally good.

How is the Procedure Performed?

Prior to the reconstruction of the nail bed, the patient is subjected to an x-ray procedure to assess the extent of the injury.

If there is a hematoma, the blood is first drained by making a small hole in the nail, relieving the pressure and providing relief from pain and inflammation in the process.

To restore the nail bed, it is often necessary to first repair and align any bone fragments. If there are larger fractures, the bone may need to be splinted. The same is true for injured tendons.

Once the affected bones and tendons are repaired, the appearance of the nail bed is restored to normal by using flaps of skin or a skin graft taken from other parts of the body. Common donors are the unaffected fingers or toes. These are usually split-thickness grafts.

Possible Risks and Complications

The reconstruction of nail bed with graft is associated with some risks and potential complications. These include:

  • Allergic reaction to the graft
  • Scarring
  • Nail deformities - These are highly likely if the injury or trauma to the nail is severe. These complications may become more visible as the nail grows, which may take 3 to 6 months.


  • “Nail bed injuries.” American Society for Surgery of the Hand.

  • Takeda A, Fukuda R, Takahashi T, Nakamura T, Uchinuma E. “Fingertip reconstruction by nail bed grafting using thenar flap.” Aesthetic Plastic Surgery. 2002 March; 26(2): 142-145.

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