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Principles and overview of nail surgery

Authors
Phoebe Rich, MD
Julie A Jefferson, MD
Section Editor
Stanley J Miller, MD
Deputy Editor
Rosamaria Corona, MD, DSc

INTRODUCTION

Nail surgery is performed to remove benign and malignant nail tumors, alleviate pain secondary to ingrown and traumatized nails, and diagnose clinically ambiguous lesions and dystrophies [1,2]. Because of the propensity for scarring and inadequate sampling, nail surgery is best performed by clinicians with appropriate training and experience. Prerequisites for a successful nail biopsy include a thorough understanding of nail anatomy, adequate anesthesia and hemostasis, and proper patient selection and preparation. Nail avulsions, biopsies, and excisions can be safely performed in the office setting [2].

This topic will discuss the surgical anatomy of the nail apparatus, preoperative patient evaluation, anesthesia techniques, basic surgical procedures, and surgical treatment of specific nail lesions.

Nail disorders, nail biopsy techniques, nail plate avulsion, and chemical matricectomy are discussed separately. (See "Overview of nail disorders" and "Nail biopsy: Indications and techniques" and "Nail avulsion and chemical matricectomy", section on 'Nail avulsion' and "Nail avulsion and chemical matricectomy", section on 'Chemical matricectomy'.)

SURGICAL ANATOMY OF THE NAIL UNIT

The nail unit is composed of the nail matrix, the nail bed, the proximal and lateral nail folds, and the hyponychium (picture 1 and figure 1A-C) [1,3].

The nail matrix is the germinative epithelium from which nail matrix keratinocytes differentiate to ultimately form the nail plate [1,3,4]. Although most of the nail matrix is hidden beneath the proximal nail fold, the distal third of the nail matrix is sometimes visible through the proximal portion of the nail plate as a half-moon shaped structure called the lunula [1,3,4]. The proximal nail matrix forms the dorsal (superior) portion of the nail plate whereas the distal nail matrix forms the ventral (inferior) surface of the nail (figure 2) [1,3-5]. The proximal portion of the nail matrix is responsible for the production of approximately 80 percent of the nail plate, allowing the nail plate to achieve a natural convex curvature as it grows distally [4,5].

                             

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Literature review current through: Nov 2016. | This topic last updated: Wed May 18 00:00:00 GMT+00:00 2016.
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