Midline/paramedian longitudinal matrix excision with flap reconstruction: Alternative surgical techniques for evaluation of longitudinal melanonychia

Background: Surgical evaluation of longitudinal melanonychia requires biopsy of the nail matrix. Previous publications have presented detailed Surgical approaches to this problem. However, discussion of longitudinal excision with local matrix flap reconstruction is documented sparsely in the literature. Objective: To describe the indications for and technique of performing a longitudinal, full-thickness excision for longitudinal melanonychia; as this surgery poses a high risk of postoperative split nail, reconstruction is essential. Three local matrix flaps are detailed to maximize functional and cosmetic results. Methods: The authors detail the different procedures, with several illustrations and clinical photographs highlighting the techniques. Results: These techniques provide the surgeon with additional approaches to excise lesions of longitudinal melanonychia and reconstruct the Surgical defects. Limitations: All surgeries of the nail matrix pose a risk of postoperative nail dystrophy and/or split nail Conclusion: The different flaps provide elegant local alternatives to second-intention healing and maximize cosmetic and functional results after matrix excision with narrow margins for longitudinal melanonychia. (J Am Acad Dermatol 2010;62:627-36.)