author : Dr Cliff Rosendahl, Associate Professor, School of Medicine, The University of Queensland, Australia, 2013. Reviewed by Prof Luc Thomas, Lyon 1 University, France. Updated by Dr Todd Gunson, Dermatologist, Auckland, New Zealand in July 2014 .

What is the nail matrix?

The nail matrix consists of specialize cells that produce the collar denture. It is located at the end of the finger ( finger or toe ) under the the skin beyond the distal phalangeal joint. It can be seen protruding as a ashen half-moon form at the base of some nails .

What is nail matrix biopsy?

Nail matrix biopsy is a surgical procedure in which a tissue specimen is obtained from the collar matrix .

Why is nail matrix biopsy undertaken?

Nail matrix biopsy is contract to make or confirm a diagnosis of a disorderliness that is affecting the breeze through plate. The pursuit number describes some conditions in which this routine may be undertaken.

How is a nail biopsy done?

Nail matrix biopsy is normally undertaken under local anesthetic. Most much a digital barricade is performed, whereby the sensational nerves entering at the establish of the affect finger or toe are numbed via an injection. versatile techniques are used to biopsy the nail matrix depending on the situation and the specialist ‘s preference. The overlying nail plate may be removed for diseased examination, or replaced after the routine. All techniques involve examining the matrix for the origin of the problem. It is significant that adequate and allow sample is taken to make an accurate diagnosis, while minimising permanent damage/scarring to the matrix tissue. Techniques include :

  • Thin cross

    incisional

    biopsy

  • Tangential (shave) biopsy
  • punch biopsy

To minimise nail muscular dystrophy, the biopsy should be performed on the distal matrix wherever possible, because this is responsible for producing the bottom of the breeze through plate .

Trap door technique

One technique is the “ trap doorway ” or “ pop the hood ” method acting used to biopsy of pigment nail matrix lesions. This allows a send view of the nail matrix permitting accurate targeted biopsy of the wound .

  • After local anaesthetic has been injected as a digital block using lignocaine without epinephrine, a tourniquet is applied to reduce bleeding. The time the tourniquet is applied is recorded. The proximal smash fold

    is completely cut through on each side approximately halfway back to the distal interphalangeal joint (figure 1).

  • The nail plate is separated from the nail bed with a Freer elevator, taking care to keep distal to the half-moon (the half-moon) to avoid injuring the nail matrix (figure 2).
  • The nail plate is hinged up vertically like a car bonnet being opened (figure 3).
  • The nail bed has been injured by the procedure but the nail matrix is clearly and completely seen in pristine condition. Parallel lines of pigmentation can be seen in this case. The biopsy can be targeted to include a complete longitudinal sample of this portion of the nail matrix (figure 4).
  • The nail plate is retracted with a suture anchored on the tourniquet. The biopsy specimen is scored with a scalpel then shaved at least 1-mm thick. This is adequate for dermatopathological assessment if the lesion is thought to be thin. Extreme care is taken to avoid crushing the sample with forceps (figure 5).
  • The biopsy specimen is placed in formalin in a specimen container. The request form should carefully describe the lesion and the procedure. The specimen must be accurately labelled. It is recommended that the diagnostician is directly contacted to ensure correct processing of the specimen (figure 6).
  • A suture is placed in each of the incisions (figure 7).
  • A suture is placed to hold the nail plate onto the nail bed (figure 8).
  • The tourniquet is removed and the tourniquet removal time should be recorded.
  • After removing the sutures a week later, the nail plate is vulnerable to “popping” and can be supported with tape.
Nail biopsy

Nail biopsy figure 1

Nail biopsy figure 2

Nail biopsy trope 3

Nail biopsy figure 4

Nail biopsy figure 5

Nail biopsy name 6

Nail biopsy figure 7

Nail biopsy figure 8

What are the risks of nail biopsy?

Nail biopsy can lead to any of the common complications from a surgical procedure, such as bleeding, infection, steel damage, and scar. Scarring of the pinpoint matrix is coarse and may result in permanent disfigurement of the nail plate. dogged paresthesia ( abnormal sensation ) is one of the most coarse complications ( 7 % in one cogitation ), probably due to damage to belittled nerves during the operating room. Overall, the complication rate following smash operation performed by a specialist is broken .

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