Nail Surgery: Biopsy, Avulsion, and Matricectomy

Overview / Definition Nail surgery involves a variety of procedures aimed at diagnosing and treating conditions affecting the nail unit. The most common surgical procedures include nail biopsy, nail avulsion, and matricectomy. Each technique serves distinct purposes, from obtaining tissue for histopathological examination to addressing painful or destructive nail conditions. Epidemiology Nail disorders are prevalent in both the general population and among dermatology patients. Common indications for nail surgery include: Onychomycosis (fungal nail infection) Nail trauma and ingrown nails Benign and malignant tumors of the nail unit Psoriasis and other inflammatory conditions The exact prevalence of nail surgery procedures is difficult to ascertain, but conditions leading to surgery are often seen in primary care and dermatology practices. Pathophysiology / Mechanism The nail unit consists of the nail plate, nail bed, and nail matrix, each playing a critical role in nail health. Various pathologies can disrupt these structures: Nail Biopsies: Used to evaluate suspicious lesions. The nail matrix or bed may be involved, depending on the lesion's location. Nail Avulsion: Indicated for conditions such as severe onycholysis or when the nail is causing pain, often due to trauma or ingrowth. Matricectomy: Permanent removal of the nail matrix to prevent recurrence of ingrown nails or to treat nail tumors. Clinical Presentation Patients presenting for nail surgery may exhibit a variety of symptoms, including: Localized pain or discomfort Swelling and redness around the nail Discoloration or abnormal nail growth Presence of a mass or lesion at the nail unit Recognizing the clinical signs and symptoms can guide the choice of surgical procedure. Diagnosis / Workup A thorough clinical evaluation is essential prior to nail surgery. Key steps in the diagnosis and workup include: History Taking: Assess for previous nail trauma, familial history of nail disorders, and associated sym