Basic and Intermediate Complexity Nail Procedures

  • Christopher J. MillerEmail author
  • Nathaniel J. Jellinek
  • Ali Damavandy
  • Jeremy R. Etzkorn
  • Joseph F. Sobanko
  • Thuzar M. Shin


Nail surgery allows practitioners to diagnose or treat the majority of nail conditions. Successful nail surgery requires knowledge of anatomy and pathology, which have been detailed in prior chapters. This chapter reviews reliable approaches to common office-based procedures, including plate, bed, and matrix surgery, with punch, shave, and fusiform techniques. With a strong foundation of nail anatomy and pathology, surgeons can use these basic and intermediate surgical techniques to diagnose or treat a wide array of nail conditions.


Nail surgery Punch biopsy Wedge biopsy Shave biopsy Longitudinal biopsy Glomus tumor Digital myxoid cyst Avulsion 

Supplementary material

Video 34.1

The matrix shave technique is demonstrated with partial proximal plate avulsion, in the setting of biopsy of longitudinal melanonychia (MP4 548,119 kb)

Video 34.2

The lateral longitudinal biopsy technique is demonstrated, with key points focusing on complete matrix horn excision (MP4 379,959 kb)

Video 34.3

A technique to biopsy longitudinal erythronychia with the suspicion of the diagnosis of onychopapilloma is demonstrated (MP4 417,519 kb)


  1. 1.
    Daniel CR 3rd, Jellinek NJ. Subungual blood is not always a reassuring sign. J Am Acad Dermatol. 2007;57:176.CrossRefGoogle Scholar
  2. 2.
    Braun RP, Baran R, Saurat JH, Thomas L. Surgical pearl: dermoscopy of the free edge of the nail to determine the level of nail plate pigmentation and the location of its probable origin in the proximal or distal nail matrix. J Am Acad Dermatol. 2006;55:512–3.CrossRefGoogle Scholar
  3. 3.
    Haneke E, Baran R. Longitudinal melanonychia. Dermatol Surg. 2001;27:580–4.CrossRefGoogle Scholar
  4. 4.
    Jellinek N. Nail matrix biopsy of longitudinal melanonychia: diagnostic algorithm including the matrix shave biopsy. J Am Acad Dermatol. 2007;56:803–10.CrossRefGoogle Scholar
  5. 5.
    Richert B, Theunis A, Norrenberg S, Andre J. Tangential excision of pigmented nail matrix lesions responsible for longitudinal melanonychia: evaluation of the technique on a series of 30 patients. J Am Acad Dermatol. 2013;69:96–104.CrossRefGoogle Scholar
  6. 6.
    Jellinek NJ, Velez NF, Knackstedt TJ. Recovery after matrix shave biopsy. Dermatol Surg. 2016;42:1227–9.CrossRefGoogle Scholar
  7. 7.
    Jellinek NJ, Rubin AI. Lateral longitudinal excision of the nail unit. Dermatol Surg. 2011;37:1781–5.CrossRefGoogle Scholar
  8. 8.
    El-Shaer WM. Lateral fold rotational flap technique for treatment of ingrown nail. Plast Reconstr Surg. 2007;120:2131–3.CrossRefGoogle Scholar
  9. 9.
    De Berker DA, Baran R. Acquired malalignment: a complication of lateral longitudinal nail biopsy. Acta Derm Venereol. 1998;78:468–70.CrossRefGoogle Scholar
  10. 10.
    Reardon CM, McArthur PA, Survana SK, Brotherston TM. The surface anatomy of the germinal matrix of the nail bed in the finger. J Hand Surg Br. 1999;24:531–3.CrossRefGoogle Scholar
  11. 11.
    Baran R, Perrin C. Longitudinal erythronychia with distal subungual keratosis: onychopapilloma of the nail bed and Bowen’s disease. Br J Dermatol. 2000;143:132–5.CrossRefGoogle Scholar
  12. 12.
    Tosti A, Schneider SL, Ramirez-Quizon MN, Zaiac M, Miteva M. Clinical, dermoscopic, and pathologic features of onychopapilloma: a review of 47 cases. J Am Acad Dermatol. 2016;74(3):521–6.CrossRefGoogle Scholar
  13. 13.
    Jellinek NJ. Longitudinal erythronychia: suggestions for evaluation and management. J Am Acad Dermatol. 2011;64(167):e161–11.Google Scholar
  14. 14.
    Collins SC, Cordova KB, Jellinek NJ. Midline/paramedian longitudinal matrix excision with flap reconstruction: alternative surgical techniques for evaluation of longitudinal melanonychia. J Am Acad Dermatol. 2010;62:627–36.CrossRefGoogle Scholar
  15. 15.
    McDermott EM, Weiss AP. Glomus tumors. J Hand Surg Am. 2006;31:1397–400.CrossRefGoogle Scholar
  16. 16.
    Bhaskaranand K, Navadgi BC. Glomus tumour of the hand. J Hand Surg Br. 2002;27:229–31.CrossRefGoogle Scholar
  17. 17.
    Trehan SK, Athanasian EA, DiCarlo EF, Mintz DN, Daluiski A. Characteristics of glomus tumors in the hand not diagnosed on magnetic resonance imaging. J Hand Surg Am. 2015;40:542–5.CrossRefGoogle Scholar
  18. 18.
    Roan TL, et al. Surgical technique innovation for the excision of subungual glomus tumors. Dermatol Surg. 2011;37:259–62.CrossRefGoogle Scholar
  19. 19.
    Lee IJ, Park DH, Park MC, Pae NS. Subungual glomus tumours of the hand: diagnosis and outcome of the transungual approach. J Hand Surg Eur Vol. 2009;34:685–8.CrossRefGoogle Scholar
  20. 20.
    Lin YC, Wu YH, Scher RK. Nail changes and association of osteoarthritis in digital myxoid cyst. Dermatol Surg. 2008;34:364–9.PubMedGoogle Scholar
  21. 21.
    de Berker D, Goettman S, Baran R. Subungual myxoid cysts: clinical manifestations and response to therapy. J Am Acad Dermatol. 2002;46:394–8.CrossRefGoogle Scholar
  22. 22.
    Lawrence C. Skin excision and osteophyte removal is not required in the surgical treatment of digital myxoid cysts. Arch Dermatol. 2005;141:1560–4.CrossRefGoogle Scholar
  23. 23.
    Baran R, Haneke E, Richert B. Pincer nails: definition and surgical treatment. Dermatol Surg. 2001;27:261–6.PubMedGoogle Scholar
  24. 24.
    Cho YJ, Lee JH, Shin DJ, Sim WY. Correction of pincer nail deformities using a modified double Z-plasty. Dermatol Surg. 2015;41:736–40.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Christopher J. Miller
    • 1
    Email author
  • Nathaniel J. Jellinek
    • 2
    • 3
    • 4
  • Ali Damavandy
    • 1
  • Jeremy R. Etzkorn
    • 1
  • Joseph F. Sobanko
    • 1
  • Thuzar M. Shin
    • 1
  1. 1.University of Pennsylvania, Department of DermatologyPennsylvaniaUSA
  2. 2.Dermatology Professionals, Inc.East GreenwichUSA
  3. 3.Department of DermatologyThe Warren Alpert Medical School at Brown UniversityProvidenceUSA
  4. 4.Department of DermatologyUniversity of Massachusetts Medical SchoolWorcesterUSA

Personalised recommendations