title: Island nail flap in the treatment of foot macrodactyly of the first ray in children: report of two cases.
abstract: OBJECTIVE
  We evaluated the result of a combined single-stage surgery in the treatment of first ray macrodactyly in children.
  
  
  BACKGROUND
  Macrodactyly is a rare congenital abnormality that involves thickening of both the soft tissue and bone of the affected digits. It is more frequent in fingers than toes, where there is less neural involvement. Increased growth is also seen in neurofibromatosis, hemangiomatosis, arteriovenous malformations, congenital lymphedema, and syndromes such as Klippel-Trenaunay-Weber syndrome and Proteus syndrome. The goal of treatment is to obtain a pain-free, functional foot that can accommodate normal shoes. Treatment of macrodactyly of the first ray generates numerous difficulties since ray resection, which has been recommended for other toes as a means to of shortening and narrowing the foot, cannot be performed. In addition to this, cosmetic results are better if the nail is preserved.
  
  
  METHODS
  We retrospectively reviewed our cases of first ray macrodactyly treated by a single-stage multiple-technique procedure.
  
  
  RESULTS
  We obtained satisfactory results, in that same-sized shoes could be worn on by our patients and patients and family were happy with the outcome. However, one of our cases patients lost the nail 10 months postoperatively.
  
  
  CONCLUSIONS
  We believe that island-nail transfer in children obtains excellent results.
authors.affiliation: Department of Trauma and Orthopedic Surgery, Pediatric Orthopedic Unit, Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013, Seville, Spain, franciscoj.downey.sspa@juntadeandalucia.es.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Downey-Carmona
authors.forename: Araceli
authors.initials: A
authors.lastname: Lagares
authors.forename: David
authors.initials: D
authors.lastname: Farrington-Rueda
authors.forename: José
authors.initials: J
authors.lastname: Lirola-Criado