Free vascularized osteoonychocutaneous flap for reconstruction of the distal phalanx of the fingers.

The "twisted toe flap" offers a solution for reconstruction of the distal phalanx of the fingers; however, a major problem with this method is that the second donor toe must be sacrificed. Two clinical cases are reported in which free vascularized "osteo-onychocutaneous" flaps modified wrap-around flaps were successfully used. The use of the free vascularized osteo-onychocutaneous flap is suggested as a superior method of reconstruction for treating distal phalangeal loss in the fingers.