Extracellular Matrix Graft for Reconstruction after Nail Bed Excision

There have been multiple nail bed deformities described that require excision for diagnostic and therapeutic purposes. To the best of our knowledge, there have been no cases in the literature describing nail bed reconstruction with an extracellular matrix graft after nail bed excision. However, the effectiveness of acellular micronized extracellular matrix for open fingertip injuries has been documented. The ACell MatriStem^® Wound Matrix is comprised of naturally-occurring porcine urinary bladder matrix. This material supplies extracellular matrix proteins, delivers growth factors and recruits differentiated cells into the wound site. In addition, it contains an intact basement membrane and collagen which acts as a scaffold for regeneration.

We present a series of 9 patients (5 males and 4 females, mean age: 36.3) from December, 2015 to January, 2017 who underwent nail bed excision in the setting of a nail bed lesion, after which extracellular MatriStem^® Wound Matrix (ACell Inc., Columbia, MD) was applied. All patients underwent total onychectomy and wide local excision (total excisional diameter ranging from 6 mm – 14 mm). This was in the setting of longitudinal melanonychia (4), chronic myxoid cyst (1), split nail deformity (1), verruca vulgaris (1) and squamous cell carcinoma (2). Of note, upon histological examination, none of the patients had melanoma. There were 9 fingers treated. All patients in the series had a follow up appointment every three to four weeks and were followed until complete wound healing. After a period of six weeks, complete healing of the nail bed was achieved in all cases. Furthermore, nail bed deformities were not identified in any patients.

The use of an extracellular matrix graft after excisional biopsy of the nail bed prevents nail matrix scarring. This decreases the risk of postoperative nail dystrophy and also decreases the need for further reconstructive procedures, including nail bed grafting.

References

Dreifuss SE, Wollstein R, Badylak FS, et al. Acellular micronized extracellular matrix and occlusive dressings for open fingertip injuries. Plast Aesthet Res 2015;2:282-3

Rosendahl C, Cameron A, Wilkinson D, et al. Nail matrix melanoma: consecutive cases in a general practice. Dermatol Prac Concept 2012;2(2):0202a13 

Jefferson J, Rich P. Melanonychia. Dermatol Res Pract 2012;:952186

Duarte AF, Correia O, Barros AM, et al. Nail melanoma in situ: clinical, dermoscopic, pathologic clues, and steps for minimally invasive treatment. Dermatol Surg 2015;41(1):59-68