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Nail apparatus deformities associated with burn injuries can cause significant functional and aesthetic concerns. The majority of perionychial deformities result from eponychial retraction and scarring, whereas a minority are due to direct damage to the regenerative part of the nail complex. A variety of different techniques have been described for reconstruction including the use of local flaps, skin/composite grafts, and microvascular transfer. The authors review the different strategies available in the current burns literature and present an algorithm for the management of perionychial burn deformities.