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Matriectomy: for Nail Pathology

- Discussion:
    - indicated for chronic ingrown toe nails or for any condition in which the nail shape is thickened and distorted;

- Surgical Matriectomy:
    - excision of matrix w/ scapel may be used but has high complication rate;
    - for adequate exposure of the entire germinal matrix, two oblique incisions are made at the proximal edges of the nail fold;
          - the nail fold is then flipped proximally;
    - the distal nail bed including the superficial periosteum is removed;
    - take care not to injure the extensor tendon;
    - consider application of STSG or free nail graft;
    - as an alternative consider using an extended V-Y distal volar flap (Atasoy);
          - see V-Y distal volar flap;
          - after the sterile and germinal matrix is removed, the flap covers the defect;

- Chemical Matriectomy:
    - chemical destruction of the nail matrix is preferable to the scapel technique;
          - this requires exposure of the entire target nail bed to the chemical in order to avoid remnant nail growth;
         - note that the germinal matrix extends proximally to the metaphyseal flares of the distal phalanx;
    - chemical agents:
         - phenol alcohol (88% liquified): applied for 30 sec and is then wash out w/ isopropyl alcohol;
         - silver nitrate: may be applied to granulation tissue;
         - hydrogen peroxide (10%);

- Preop Considerations

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