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Original Communications| Volume 25, ISSUE 6, P1114-1117, November 2000

Examination of the anatomic relationship of the proximal germinal nail matrix to the extensor tendon insertion

      Abstract

      The purpose of this study was to delineate the relationship of the terminal extensor tendon insertion to the proximal limit of the germinal nail matrix. Sixteen fresh-frozen human cadaver fingers without any evidence of trauma (average age, 55 years; 3 males and 1 female) were used for this study. Under ×25 magnification the proximal limit of the germinal nail matrix and the terminal bony insertion of the extensor tendon were identified. The distance from the terminal tendon insertion to the germinal nail matrix was ascertained using precision calipers. The average distance from the terminal extensor tendon insertion to the proximal edge of the germinal nail matrix was found to be 1.2 mm. We conclude that the proximal limit of the germinal matrix is extremely close to the terminal extensor tendon bony insertion. When the extensor tendon insertion is visualized during operative exposures of the dorsum of the distal phalanx, care should be taken to avoid damaging the germinal matrix. Conversely, when the nail bed is being completely excised, visualization of the insertion of the extensor tendon will indicate that further proximal dissection is not required. (J Hand Surg 2000;25A:1114-1117. Copyright © 2000 by the American Society for Surgery of the Hand.)

      Keywords

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      References

        • Rockwell WB
        • Wray Jr, RC
        Nail bed injuries and reconstruction.
        in: Surgery of the hand and upper extremity. Vol. 1. McGraw-Hill, New York1996: 1101-1111
        • Howard FH
        Symposium: fingertip injuries.
        Contemp Orthop. 1986; 13: 57-86
        • Guy RJ
        The etiologies and mechanisms of nail bed injuries.
        Hand Clin. 1990; 6: 9-19
        • Coyle Jr, MJ
        • Leddy JP
        Injuries of the distal finger.
        Primary Care. 1980; 7: 245-258
        • De Berker D
        • Mawhinney B
        • Sviland L
        Quantification of regional matrix nail production.
        Br J Dermatol. 1996; 134: 1083-1086
        • Zook EG
        Anatomy and physiology of the perionychium.
        Hand Clin. 1990; 6: 1-7
        • Stern PJ
        • Kastrup JJ
        Complications and prognosis of treatment of mallet finger.
        J Hand Surg. 1988; 13A: 329-334
        • Brown RE
        • Zook EG
        • Russell RC
        • Kucan JO
        • Smoot EC
        Fingernail deformities secondary to ganglions of the distal interphalangeal joint (mucous cysts).
        Plast Reconstr Surg. 1991; 87: 718-725
        • Gingrass MK
        • Brown RE
        • Zook EG
        Treatment of fingernail deformities secondary to ganglions of the distal interphalangeal joint.
        J Hand Surg. 1995; 20A: 502-505
        • Zook EG
        Complications of the perionychium.
        Hand Clin. 1986; 2: 407-427
        • Zook EG
        • Van Beek AL
        • Russell RC
        • Beatty ME
        Anatomy and physiology of the perionychium: a review of the literature and anatomic study.
        J Hand Surg. 1980; 5: 528-536
        • Keyser JJ
        • Littler JW
        • Eaton RG
        Surgical treatment of infections and lesions of the perionychium.
        Hand Clin. 1990; 6: 137-153
        • Ditre CM
        • Howe NR
        Surgical anatomy of the nail unit.
        J Dermatol Surg Oncol. 1992; 18: 665-671
        • Guéro S
        • Guichard S
        • Fraitag SR
        Ligamentary structure of the base of the nail.
        Surg Radiol Anat. 1994; 16: 47-52
        • Shrewsbury M
        • Johnson RK
        The fascia of the distal phalanx.
        J Bone Joint Surg. 1975; 57A: 784-788
        • 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. 1999; 24B: 531-533
        • Hyder N
        Ingrowing toe nails: the extent of the germinal matrix.
        J Bone Joint Surg. 1994; 76B: 501-502
        • Brewster NT
        • Howie CR
        Excision of the germinal matrix: a modification.
        J R Coll Surg Edinb. 1995; 40: 59
        • Austin RT
        A method of excision of the germinal matrix.
        Proc R Soc Med. 1970; 63: 757-758
        • Van Beek AL
        • Kassan MA
        • Adson MH
        • Dale V
        Management of acute fingernail injuries.
        Hand Clin. 1990; 6: 23-35