9.0: Thursday, March 17, 2005

Excision of Nail Retention Cysts: A New Technique

Michael J. Orseck, MD and R. Christie Wray, MD.

Nail retention cysts are a common late complication following revisional finger tip amputation. Treatment includes removal of the nail fragment and complete excision of the nail matrix. Recurrence following excision of the nail cyst is common and results from failure to recognize and excise the residual matrix. Recognition of the residual matrix can be improved by staining with methylene blue, facilitating complete excision. This technique offers a reliable and easy surgical technique for the management of nail retention cysts.

Five patients with a remote history of fingertip injury requiring revisional amputation presented with an extrusion of keratinous material through the amputation stump consistent with a nail retention cyst. One patient had a previous attempt at excision of a nail retention cyst. Pain was the chief complaint in all five patients. One patient presented with an infection involving the area of keratinous extrusion. All patients underwent successful excision of a nail retention cyst using this new technique.