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Journal of Postgraduate Medicine, Vol. 52, No. 3, July-September, 2006, pp. 218 Images In Medicine Post traumatic ectopic nail Rajashekar M, Bhandary S, Shenoy M*, Sali AR Departments of General Surgery and *Dermatology, K. S. Hegde Medical Academy, Mangalore, Karnataka - 575018 Code Number: jp06069 A 19 year old, male manual labourer presented with a complaint of an additional nail over his left thumb since 1 year. This nail was noticed 2 months following a cut injury to the right nail fold sustained at work. There was no associated pain, discharge or discomfort. The additional nail had horizontal growth pattern, growing parallel and above the normal underlying nail. It required regular trimming. On examination, a nail like structure was noted above and horizontal to the normal underlying nail measuring about 7 x 5 mms. It was not fused with the underlying normal nail and there was no associated bony deformity in the terminal phalanx. Other nails were normal. A clinical diagnosis of ectopic nail (syn: onychoheterotopia) was made and it was surgically excised under local anaesthesia [Figure - 1]. Histopathological examination revealed a fully developed nail unit with a nail matrix and nail plate. No recurrence is noted 1½ years following excision. Discussion Ectopic nail (syn: onychoheterotopia) is a term used to describe nail tissue noted in a different location other than in the normal nail bed. It is an extremely rare condition with less than 40 reported cases in the literature. First reported by Ohya in 1931, they have been broadly classified as congenital and acquired, the majority of the reported cases being of the congenital type. The pathogenesis of both types remains unclear.[1] It has been postulated that the congenital type is a kind of polydactyly or are generated from stray germ cells. There are reports of familial occurrences and hence a genetic factor has also been suggested. They have also been noted in association with congenital anomalies like Pierre Robinson syndrome and in patients with anomalies of chromosome 6.[1],[2] Acquired ectopic nails occur following trauma to the nail unit and hence it has been postulated that the transfer and inoculation of the nail matrix causes the ectopic nail growth.[3] Ectopic nails have been noted on the volar and dorsal aspects of the extremities and also on multiple sites on the same patient. Vertical, horizontal and circumferential growth patterns have been reported. The absence of a proper nail fold or the absence a nail bed, is cited as cause for vertical growth pattern.[4] Associated defects in the underlying bone has been reported in both types, which suggests that the contact of the ectopic nail matrix with the periosteum could impede intra-membranous ossification and deform the bone shape.[5] The treatment of ectopic nail is surgical excision. If a wide defect results following excision, a skin flap or a V-Y advancement flap may be required to cover the defect. Recurrence following excision has been reported in a few patients.[1] References
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