Is the nail matrix removed when taking out a fingernail?

Nail Matrix Removal During Nail Avulsion

No, the nail matrix is NOT removed during standard nail avulsion procedures—only the nail plate is removed, while the matrix is preserved to allow nail regrowth. 1, 2

Understanding Nail Anatomy and Avulsion

The nail apparatus consists of distinct components with different functions:

• The nail matrix is the germinal tissue located under the proximal nail fold that produces the nail plate throughout life 3
• The nail plate is the visible hard structure that is the permanent product of the matrix 3
• The nail bed extends from the lunula to the hyponychium and has firm attachment to the nail plate 3

During nail avulsion, only the nail plate is removed—the matrix remains intact and protected under the proximal nail fold. 2, 3

Standard Nail Avulsion Technique

When removing a fingernail, the procedure involves:

• Careful removal of the nail plate only, particularly when associated with severe/painful lesions, pressure hematoma, or subungual abscess 2
• Meticulous cleaning of the nail bed after plate removal 2
• The matrix is left undisturbed to allow the nail to regenerate 3, 4

The nail bed may be denuded during avulsion, but this is distinct from matrix removal 3

When Matrix IS Intentionally Removed (Matricectomy)

Matrix removal is a completely different procedure called matricectomy, which is performed only in specific circumstances:

• Matricectomy refers to complete extirpation of the nail matrix, resulting in permanent nail loss 5
• This is indicated only for chronic conditions like recalcitrant ingrown toenails, onychogryphosis, or chronic painful nails 5
• Partial matricectomy may be performed on lateral horns only for ingrown nails 5

Critical Distinction for Clinical Practice

The key pitfall to avoid: Confusing nail avulsion (temporary nail plate removal) with matricectomy (permanent matrix destruction). 5

• Standard nail avulsion preserves the matrix → nail regrows 2, 3
• Matricectomy destroys the matrix → permanent nail loss 5
• After standard avulsion, nails should be cut regularly until the plate grows reattached 2, 6

Special Considerations

For diagnostic biopsies of subungual melanomas:

• The nail should be removed sufficiently for the nail matrix to be adequately sampled when clinically obvious tumor is present 1
• This represents a specific exception where matrix tissue may be biopsied, not a standard avulsion 1