Surgical anatomy of the nail

Knowledge of nail anatomy is a prerequisite for both diagnostic and therapeutic purposes. The nail apparatus is a highly specialized structure, but is in close relationship to the distal phalanx which supports it and to the pulp which carries the sensory receptors and is involved in pinching. It can be divided by the nail plate into the perionychium underneath, and the paronychium above. The perionychium includes, from proximal to distal: the nail matrix, the sole structure responsible for the growth of the nail plate; the nail bed, mostly responsible for adhesion of the plate; and the hyponychium, which is the most distal part, where the nail plate loses its adhesion. The paronychium comprises three nail folds, one proximal and two lateral, that embed the nail plate. The nail apparatus is richly vascularized, with three main sources, and richly innervated, which explains why trauma and surgery are so painful.