Nail surgery, particularly when it involves the matrix, may lead to permanent nail deformity, with associated disruption in digital function. Soft tissue rearrangement of the nail tissues, nail flaps, can be used to reconstruct the nail to preserve a more normal nail plate. Other nail flaps can also be used to correct congenital malalignment, to cover full thickness nail unit defects, and for nail fold reconstruction. The indications and techniques for successful flap reconstruction are reviewed.