Introduction Clinical definition scar that produces an 'empty' or 'blank' longitudinal area of nail between two normal regions of nail Etiology Pathophysiology caused by scar in the germinal matrix that causes absence of nail production can occur as a sequelae of nail bed injuries infections (i.e. paronychia) Anatomy Perionychium consists of nail bed login to view 7 more bullets nail fold login to view 3 more bullets eponychium login to view 1 more bullet paronychium login to view 1 more bullet hyponychium login to view 1 more bullet Presentation History patient will report fingertip injury in the form of trauma or infection in the past Symptoms common symptoms painless complaint is typically cosmetic in nature Physical exam careful inspection of the nail to identify any 'blank' areas of nail Imaging Radiographs not typically warranted obtain if suspicious of underlying bony etiology Treatment Nonoperative observation alone indications login to view 1 more bullet Operative scar resection and primary closure indications login to view 2 more bullets scar resection and full thickness nail bed graft from second toe indications login to view 4 more bullets Techniques Scar resection and primary closure indicated for germinal matrix if size <2mm Scar resection and full thickness nail bed graft from second toe preferred for geminal matrix if size > 2mm Complications Recurrence of split nail Persistent cosmetic deformity Donor site morbidity