Copyright © 2017 Aksoy B.. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 1 doi: 10.18282/jsd.v3.i1.167 CASE REPORT A novel surgical method for total nail ablation: Use of triple flap technique Berna Aksoy 1,2* 1 Bahcesehir University, Faculty of Medicine, Dermatology Department, Istanbul, Turkey 2 VM Medicalpark Hospital, Dermatology Clinic, Kocaeli, Turkey Abstract: Total nail ablation for the treatment of onychodystrophies can be performed by using chemicals, surgical resection or laser ablation of nail matrix. A female patient with bilateral severe onychodystrophy as a result of inadvertent previous nail surgeries was treated surgically. Proximal complete nail matrix resection and distal 10 mm wide transverse strip partial nail bed resection were performed. A 5 mm wide transverse strip of nail bed was left intact proximally. Proximal nail matrix defect was closed by using the skin of proximal nail fold. The distal nail bed defect was reconstructed by using triple fap technique which was composed of a main central advancement fap containing ventral toe skin and two side faps containing nail fold skin. The patient healed without any problem and her nail problem was treated successfully. The cosmetic appearance of her frst toes was acceptable. Surgical nail ablation followed by volar skin coverage of dorsal surface of the distal phalanx bone by using triple fap technique is an efective surgical treatment method for the correction of advanced nail plate deformities requiring total nail ablation. Keywords: ablation; dystrophy; fap; nail; onychodystrophy; surgery; treatment Citation: Aksoy B. A novel surgical method for total nail ablation: Use of triple fap technique. J Surg Dermatol 2018; 3(1): 167; http://dx.doi.org/10.18282/jsd.v3.i1.167 *Correspondence to: Berna Aksoy, VM Medicalpark Hastanesi, Ovacik mah, D-100 Karayolu Ustu, No: 36, Basiskele, Kocaeli, Turkey; bmaksoy@mynet.com, bernaaaksoy@gmail.com Received: 18 th August 2017; Accepted: 29 th September 2017; Published Online: 30 th November 2017 Introduction When a nail becomes severely deformed permanent to- tal ablation of the nail is the best choice of treatment [1] . Here we describe a case with severe bilateral great toe ony- chodystrophy treated by total surgical nail matrix excision followed by plantar skin coverage of dorsal aspect of distal part of great toe by using a novel fap technique for provid ing protection in the absence of a nail plate. Surgical technique and case report A 25 years old female patient with bilateral severe ony- chodystrophy characterized by nail plate thickening and deformation resulting from inadvertent previous nail surgeries visited to our clinic ( Figure 1). During the treatment of the patient, the principles of 1975 Declaration of Helsinki were followed. Surgical intervention was performed under local digital bloc anesthesia and Salem’s digital tourniquet. Proximal complete nail matrix resection including the underside of the proximal nail fold was performed following total nail plate avulsion. To prevent postoperative nail spike formation, nail matrix horns were ablated by using electrocautery after total surgical resection of nail matrix was completed. Approximately 8–9 mm wide transverse strip distal nail bed resection was performed to replace thin and fragile soft tissue of nail bed with thick and strong tissue of plantar skin. A 5 mm wide strip of nail bed was left intact proximally between two resection sites for cosmetic reasons (Figure 2A). Proximal nail matrix defect was closed by using the skin of proximal nail fold. The distal nail bed defect was reconstructed by using triple fap technique which was composed of a main central advancement fap containing ventral great toe skin and two side faps containing nail fold skin of both sides of distal great toe (Figure 2B). The side faps containing nail fold skin bilaterally were raised to obtain maximum dorsal mobilization of the central advancement flap containing plantar skin of distal part of great toe. Each one of these side faps was shortened 2 mm from distal edge of the fap for better coaptation following dorsal transfer of central advancement fap. All the faps were sutured in their fnal places after removal of tourniquet and control of bleeding. Operation is completed with wound dressing with slight