1. Home
  2. Skeleton
  3. Diagnosis
  4. Indications
  5. Treatment

Authors of section


Khairul Faizi Mohammad, Brad Yoo

Executive Editors

Markku T Nousiainen, Richard Buckley

Open all credits

Nail bed excision

1. Introduction

Avulsed nails can either be reinserted or removed.

The nail bed, if damaged, will result in abnormal toenail growth.

A matricectomy can be performed either with direct dissection/curettage or chemically.

NOTE: The procedure for nail bed excision of a lesser toe is exactly the same as that of the hallux. To illustrate the procedure, we will use the illustrations prepared for the hallux.
Avulsed nail

2. Toenail removal


With the patient placed supine, the foot is prepped up to the ankle. Inject a digital block bilaterally at the base of the proximal phalanx. Avoid usage of epinephrine.

Exsanguinate and apply a tourniquet.

Nail removal

Frequently, the nail can be removed with minimal force. If needed, use a spatula to free the nail from the nail bed using blunt dissection up under the ungual fold.

The nail can similarly also be freed from dorsal soft tissues.

Freeing of the nail from the nail bed using blunt dissection up under the ungual fold

Use pliers to remove the nail in one piece if needed.

Nail removal

Matricectomy dissection

If nail bed ablation is desired, the entire germinal matrix needs to be removed to prevent the nail's regrowth.

Outline of matricectomy

Make oblique incisions medially and laterally at the proximal corner of the ungual folds, down to the dermis layer.

Medial and lateral incisions are made

The inferior surface of the ungual fold will contain matrix tissue. Insert a scalpel parallel to the ungual fold and separate the ungual fold sharply from the matrix.

Separation of the ungual fold from the matrix

Carry this sharp separation bilaterally to join the oblique incisions.

Distal transverse cut

Perform a transverse cut of the nail bed, slightly distal to the lunula. This cut is carried down to the bone.

Proximal transverse cut

The matrix is then dissected out in one piece using sharp dissection. The resection site is checked to see whether there may be any matrix left.

Resection of the matrix

3. Closure

Soft tissues are apposed using resorbable sutures. If there are not enough soft tissues for closure, a small portion of the distal phalanx may be excised. This resection will enable primary closure.