The evidence that decides most repairs is on the inside of the tyre, where nobody ever looks. The inner liner is a layer of butyl rubber bonded across the whole inner surface, and its only job is to hold the air. In a healthy tyre it is even, dull and unmarked. In a tyre that has been driven any distance flat it is nothing of the sort: the sidewalls have folded in on themselves and rubbed against the tread, and that friction leaves a scuffed band running right round, sometimes a fine black powder collecting in the bottom of it, sometimes wrinkling or crumbling where the rubber has broken down with the heat.
Once that is there the answer is a new tyre, and it does not matter how neat the nail hole in the tread happens to be. Running flat destroys the casing rather than the surface, and a patch bonded onto a liner that is already shedding has nothing dependable to hold on to. It is also the main reason we would rather you left the car where it stopped and let us come to it. A tyre that could have been repaired at the kerb outside your door very often cannot be repaired after a mile of hunting for somewhere better to stand.
The first job is not the repair, it is the verdict. That work happens where the car is, on Hoxton Street or on a driveway in Hoxton Square, with the wheel off, the tyre inspected from the inside and a proper plug-patch fitted rather than a can of foam. Nothing is towed out of the Charles Square area or Whitmore Estate; the work finishes there. Pressures set before we leave Whitmore Estate, and the same on Old Street. N1 takes in Pitfield Street and Kingsland Road, and we work the lot.

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The awkward thing about a puncture at the market end of Hoxton Street is that there is nowhere obvious to stop, so the instinct is to keep going until something opens up. That instinct is what turns a repair into a replacement. If the pressure has gone, the better move is to pull in wherever you are, even somewhere inconvenient, and let us come to the car there. A tyre standing still on a flat is not getting any worse. A tyre being driven on one is getting worse by the yard.
The nail was in the middle of the tread and the outside of the tyre looked perfectly sound. Tipping the casing over produced a handful of fine rubber powder, which is the liner coming apart, and that ended the conversation.
The driver honestly reported going about two hundred yards. The scuff band inside said considerably more, and that is not a criticism of anybody, because distance is very hard to judge from the seat of a car that is limping.
Stopped as soon as the pressure went, called from a bay near Charles Square, and the inside of the tyre was untouched. Patched, balanced and back on the car, with nothing lost but half an hour of an afternoon.
Less far than people hope. At walking pace on a level surface you might move a car a short distance to somewhere safe without doing structural harm. At road speed the sidewalls are folding hundreds of times a minute and the inside is being destroyed within a few hundred yards.
It usually does, which is the trouble with it. Run flat damage happens to the inner surface and to the casing beneath it, and the outside can look untouched with a tidy little nail sitting in the tread. The only honest inspection is the one done with the tyre off the wheel.
Two things. It takes away the airtight layer, so even a perfect patch would be sitting on rubber that is coming apart around it, and it tells you the casing underneath has been overheated and worked far beyond what it was built for. Neither of those is repairable.
You are told before anything else happens, and in most cases a replacement in your size is already on the van, so the car is finished on the same visit. If yours is an unusual size we say so on the phone rather than after we have arrived and jacked it up.
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