Department of Orthopaedic Surgery University of Rochester Medical Center Rochester, NY http://dx.doi.org/10.1016/j.jhsa.2012.04.030 REFERENCE 1. Trocchia AM, Hammert WC. Arterial grafts for vascular recon- struction in the upper extremity. J Hand Surg 2011;36A: 1534 –1536. LETTER TO THE EDITOR Posttraumatic Double Nail Deformity To the Editor: Ectopic nail formation is a rare disorder. Most of the reported cases have congenital origin, in which the exact pathogenesis has not been clarified. How- ever, sharp injuries to the distal phalanx can detach and transport a portion of the germinal matrix, which continues to grow in a new location. 1–7 Usually the ectopic nail is a small snag. I would like to report a posttraumatic ectopic nail that approached normal appearance. A 22-year-old soldier presented with a double nail in his left middle finger (Fig. 1). One year previously, he sustained a nail plate avulsion and a dorsal laceration proximal to the eponychium, which was sutured. The nail plate was not replaced. Two months later, he noticed a protuberance on the dorsum of the distal phalanx, followed in another month by the appearance of a second nail that continued to grow obliquely. The new nail plate in the original location was thinned, half the size of the original nail, and grew slowly. Radiography of the distal phalanx was normal. With the patient under local anesthesia, I removed the ectopic nail plate, excised the underlying nail matrix, and approximated the skin defect was primar- ily. There was no connection between the ectopic nail and the original nail. There was no recurrence of the ectopic nail at 12 months. The history of injury quickly distinguishes a post- traumatic ectopic nail from one of congenital origin. Thorough ablation of the germinal matrix should preclude recurrence. In instances of nail absence, would it be possible to divide a normal germinal matrix and successfully transplant half of it to the deficient digit? Ahmadreza Afshar, MD Department of Orthopedics Urmia University of Medical Sciences Urmia, Iran http://dx.doi.org/10.1016/j.jhsa.2012.05.008 REFERENCES 1. Chauhan CG, Diwana VK, Thakur JS. Traumatic double fingernail. J Hand Surg 2007;32E:477– 478. 2. Goikoetxea X, Etxebarria I, Careaga M. Posttraumatic ectopic nail: case report. J Hand Surg 2006;31A:819 – 821. 3. Gotani H, Teraura H, Enomoto M, Wada M, Yamano Y. Reconstruc- tion of a double nail deformity: a case report. Osaka City Med J 2000;46:31–35. 4. Mahdi S, Beardsmore J. Post-traumatic double fingernail deformity. J Hand Surg 1997;22B:752–753. 5. Rajashekar M, Bhandary S, Shenoy M, Sali AR. Post traumatic ectopic nail. J Postgrad Med 2006;52:218. 6. Riaz F, Rashid RM, Khachemoune A. Onychoheterotopia: pathogen- esis, presentation, and management of ectopic nail. J Am Acad Der- matol 2011;64:161–166. 7. Sasmaz S, Coban YK, Gumusalan Y, Boran C. Posttraumatic ectopic nail. J Am Acad Dermatol 2004;50:323–324. FIGURE 1: Double nail deformity in the middle finger. LETTER TO THE EDITOR 1511 JHS  Vol A, July 