Finger reconstruction by a free great toenail flap has the advantages of aesthetic appearance and good motor function after transplantation. However, after the foot flap is removed, repairing the defect in the donor area is difficult. In traditional surgery, free skin flap transplantation, local rotational flap [1], and transfer of adjacent area with tipped flap are generally utilized to repair the donor area defects [2,3]. However, the survival rate of postoperative skin grafts is not high, and the incidence of grafts that are not abrasion-resistant and ulcerated is high [4,5]; notably, they can cause new donor-area defects.

The advent of artificial dermis has made it possible to repair donor area defects without grafting. In 1982, Yannas et al. prepared an artificial composite dermis using a collagen matrix and a medical silicone rubber membrane, which was successfully applied as a dermal regeneration template for deep burn wound repair [6]. Subsequently, teams in the United States and Japan developed two types of artificial dermis, Integra and Pelnac, respectively [7,8]. The upper layer of dual-layer artificial dermis is a silicone rubber membrane, which controls water evaporation and prevents pathogen invasion; the lower layer is a spongy dermal scaffolding layer, which has good biocompatibility and low immunogenicity [9]. The use of artificial dermis in some traumatic hand surgeries has proven to be as effective as skin grafting, and it is now accepted as an alternative to flap reconstruction and implant grafting. It has been reported that the artificial dermal matrix undergoes vascularization and ultimately remodels into a dermal equivalent within 2–4 weeks [10].

In the past, a two-step artificial dermis was commonly used in the treatment to repair donor area defects [[11], [12], [13], [14]]. However, the patients' postoperative hospitalization was extended, nursing care was complex, and a second surgery was required, which was physically and mentally traumatizing for the patients and costly. However, several recent studies have shown that scalp and facial defects can achieve one-stage wound healing using only artificial dermis [[15], [16], [17]]. In a clinical study involving 62 patients with finger deformities, all wounds treated with the one-stage procedure healed within an average of 37 days. No early complications—such as wound dehiscence, necrosis of the dermal flap or overlying skin, vascular injury, or venous insufficiency—were observed, and none of the patients developed hypertrophic scarringwith [18]. To further study the effect of one-stage surgical artificial skin repair of great nail flap wounds, a retrospective follow-up study was conducted on 56 patients who underwent one-stage surgical artificial skin repair of great nail flap donor area defects in our department.