Definition & Overview

The partial or complete excision of nail and nail matrix is a surgical procedure that can be performed for the permanent removal of ingrown or deformed nail. The nail matrix is the layer of cells at the base of the fingernail that is responsible for nail growth. The goals of the procedure are to provide symptom relief as well as repair nail deformities. By removing the nail and the matrix, the nail will cease to grow, effectively treating the problem and preventing it from recurring.

Who Should Undergo and Expected Results

The procedure can be recommended for patients with ingrown or deformed nail.

The ingrown toenail is one of the most common medical conditions that affect the nails. It occurs when the sides of the toenail grow into the skin surrounding it. As the nail continues to grow longer, it begins to curl around the toe and starts piercing the skin. The problem most commonly affects the big toe, and is known to cause the following symptoms:

  • Pain, especially when there is pressure on the toe
  • Inflammation of the skin
  • Fluid buildup around the toe
  • Hypertrophy or skin overgrowth around the toe
  • Bleeding
  • White or yellow pus discharge


Ingrown nails are more likely to occur in patients who:

  • Cut their toenails too short
  • Cut the edges of their toenails
  • Wear tight-fitting shoes or socks
  • Have sweaty feet
  • Have naturally curved or fan-shaped toenails


Ingrown nails are graded by severity, which includes:

Stage 1 - Involves erythema, oedema, and pain Stage 2 - Involves more severe symptoms, local infection, and drainage Stage 3 - Involves severe symptoms, hypertrophy, and the formation of granulation tissue

Nail deformities, on the other hand, come in many types, such as Beau’s lines or depressions on the nail surface, brittle nails, koilonychia, leukonychia, and pitting, among many others. They are commonly caused by:

  • Injury
  • Infection, such as fungal or bacterial infections
  • Viral warts on the nail
  • Disease
  • Certain medications
  • Aging


In most cases, doctors recommend a partial excision of the nail and nail matrix for the treatment of ingrown and deformed nails. Studies show that combining the procedures produce good short-term results, with a success rate of 99.7%, with no serious complications.

How is the Procedure Performed?

A nail or nail matrix excision begins with the application of povidone-iodine solution as well as anaesthesia. The affected nail is then clamped using a tourniquet before a 7 to 8 mm incision is made along the nail. The lateral segment of the nail plate, which extends from the nail bed to the matrix, is also cut to remove the nail and the matrix using forceps. All matrices over the distal phalanx are then cleaned with a cotton-tipped swab before the wound under the proximal nail curve is sutured.

Following the procedure, topical antibiotics is applied over the affected area to help prevent the development of infection. The tourniquet is also removed, after which the wound is covered with a sterile gauze dressing for 24 hours. Aside from antibiotics, patients are also given anti-inflammatory medication to control any residual pain and are instructed on how to care for the wound before they are discharged.

The procedure, when combined with phenol ablation, results in low recurrence rate and produces the best outcome in terms of the appearance of the toe. The nail bed, nail matrix, and nail plate are then repaired following the excision procedure.

Possible Risks and Complications

The prognosis of patients who undergo the procedure is generally good. Although the surgery is linked with some potential complications, they occur very rarely. These potential complications include:

  • Distal phalanx fracture
  • Other traumatic injuries to the nail
  • Loss of nail matrix
  • Loss of nail fold
  • Failure of the nail to adhere to nail bed
  • Infection
  • Recurrence of nail fragment, when an ingrown toenail is removed


Patients are also expected to experience some pain after the procedure. Although generally tolerable, the pain level may vary depending on the size of the ingrown or the injury as well as its location.

References:

  • Karaca N, Dereli T. “Treatment of ingrown toenail with proximolateral matrix partial excision and matrix phenolization.” Ann Fam Med. 2012 Nov; 10(6): 556-559. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3495930/

  • Bharathi RR, Bajantri B. “Nail bed injuries and deformities of nail.” Indian J Plast Surg. 2011 May-Aug; 44(2): 197-202. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193631/

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