Nail Bed Regeneration by Excision of Distal Scarred Matrix in a Patient with Porphyria Cutanea Tarda.

Onycholysis secondary to nail bed scarring can be a challenging problem for hand surgeons, given the relatively few techniques available for nail bed lengthening. Here, we present the case of a patient with upper extremity onycholysis, secondary to porphyria cutanea tarda. We used a technique first described by Lemperle et al in 2003 to successfully lengthen the nail bed and improve the appearance of the nail plate. This involved full-thickness excision of a crescent-shaped wedge of the distal nail bed in all five right sided digits in a single operation. We found this technique to be simple and effective, meeting our patient's goals after just one excision.