Toenail matrix graft reconstruction for pediatric fingernail longitudinal melanonychia > 3 mm:Evaluation of the method in a series of 7 cases
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Supplementary Figure 1. Nail matrix transplantation for the treatment of longitudinal melanonychia (LM). 1A, LM on the fingernail. 1B, Surgical avulsion of the nail plate and complete excision of the pigmented lesion down to the periosteum of the distal phalanx. 1C, Harvesting a size-matched composite graft (nail matrix or matrix-bed) from the hallux or second toe. 1D, Microsurgical implantation of the toenail matrix or matrix-bed graft into the surgical defect after lesion excision. E, Reattach the avulsed fingernail plate to its anatomical position using absorbable sutures(8-0 polyglactin), and then apply a protective dressing. F, Postoperatively, immobilize using a sterile composite dressing system to promote graft adherence and survival. Supplementary table 1. Patients demographic and clinical characteristics. Supplementary Fig 2A-G. Toenail matrix-bed transplantation for the treatment of longitudinal melanonychia (LM). 2A. Preoperative photograph of the LM on left ring finger. 2B. Intraoperative findings revealed the pigment involved both the nail matrix and the nail bed. 2C. Complete excision of the pigmented nail matrix-bed from the finger. 2D. A size-matched nail matrix-bed graft was harvested from the right great toe. 2E. The harvested composite graft of the great toe nail matrix-bed was transplanted to the surgical defect after resection. 2F-2G. Postoperative outcomes demonstrating no recurrence of melanonychia or nail dystrophy in the reconstructed fingernail, with preserved toe donor-site morphology at 30-month postoperative follow-up. Supplementary Fig 3A-G. Toenail matrix transplantation for the treatment of longitudinal melanonychia (LM). 3A. Preoperative photograph of the LM on right middle finger. 3B. Intraoperative findings revealed the pigment involved both the nail matrix and the nail bed. 3C. Complete excision of the pigmented nail matrix-bed from the finger. 3D. A size-matched nail matrix-bed graft was harvested from the right great toe. 3E. The harvested composite graft of the great toe nail matrix-bed was transplanted to the surgical defect after resection. 3F-3G. Postoperative outcomes demonstrating no recurrence of melanonychia but nail longitudinal ridges in the reconstructed fingernail, with preserved toe donor-site morphology at 18-month postoperative follow-up.
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Toenail matrix graft reconstruction for pediatric fingernail longitudinal melanonychia > 3 mm can achieve functional nail restoration with low recurrence and favorable cosmetic outcomes.