Glomus tumor surgery: Difference between revisions
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*[[Surgery]] is the mainstay of treatment for glomus tumor.<ref name="pmid24470715">{{cite journal| author=Grover C, Khurana A, Jain R, Rathi V| title=Transungual surgical excision of subungual glomus tumour. | journal=J Cutan Aesthet Surg | year= 2013 | volume= 6 | issue= 4 | pages= 196-203 | pmid=24470715 | doi=10.4103/0974-2077.123401 | pmc=PMC3884883 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24470715 }} </ref> | *[[Surgery]] is the mainstay of treatment for glomus tumor.<ref name="pmid24470715">{{cite journal| author=Grover C, Khurana A, Jain R, Rathi V| title=Transungual surgical excision of subungual glomus tumour. | journal=J Cutan Aesthet Surg | year= 2013 | volume= 6 | issue= 4 | pages= 196-203 | pmid=24470715 | doi=10.4103/0974-2077.123401 | pmc=PMC3884883 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24470715 }} </ref> | ||
*Surgical resection may be performed via several approaches:<ref name="pmid15509936">{{cite journal| author=Vasisht B, Watson HK, Joseph E, Lionelli GT| title=Digital glomus tumors: a 29-year experience with a lateral subperiosteal approach. | journal=Plast Reconstr Surg | year= 2004 | volume= 114 | issue= 6 | pages= 1486-9 | pmid=15509936 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15509936 }} </ref> | *Surgical resection may be performed via several approaches:<ref name="pmid15509936">{{cite journal| author=Vasisht B, Watson HK, Joseph E, Lionelli GT| title=Digital glomus tumors: a 29-year experience with a lateral subperiosteal approach. | journal=Plast Reconstr Surg | year= 2004 | volume= 114 | issue= 6 | pages= 1486-9 | pmid=15509936 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15509936 }} </ref> | ||
**Straightforward excision using a '''nail bed margin approach''' | **Straightforward excision using a '''nail bed margin approach'''<ref name="pmid24118542">{{cite journal| author=Wang PJ, Zhang Y, Zhao JJ| title=Treatment of subungual glomus tumors using the nail bed margin approach. | journal=Dermatol Surg | year= 2013 | volume= 39 | issue= 11 | pages= 1689-94 | pmid=24118542 | doi=10.1111/dsu.12342 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24118542 }}</ref> | ||
**'''Trap-door technique''' | **'''Trap-door technique'''<ref name="pmid20438390">{{cite journal| author=Pahwa M, Pahwa P, Kathuria S| title=Glomus tumour of the nail bed treated with the 'trap door' technique: a report of two patients. | journal=J Dermatolog Treat | year= 2010 | volume= 21 | issue= 5 | pages= 298-300 | pmid=20438390 | doi=10.3109/09546630903277610 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20438390 }}</ref> | ||
**A technique described by Lee et al designed to '''conserve the nail plate itself''' | **A technique described by Lee et al designed to '''conserve the nail plate itself'''<ref name="pmid24256308">{{cite journal| author=Lee HJ, Kim PT, Kyung HS, Kim HS, Jeon IH| title=Nail-preserving excision for subungual glomus tumour of the hand. | journal=J Plast Surg Hand Surg | year= 2014 | volume= 48 | issue= 3 | pages= 201-4 | pmid=24256308 | doi=10.3109/2000656X.2013.861842 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24256308 }}</ref> | ||
**'''Transungual''' | **'''Transungual''' | ||
***The nail plate is removed and an incision is made on the nail bed. | ***The nail plate is removed and an incision is made on the nail bed. | ||
Revision as of 22:38, 14 May 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Soujanya Thummathati, MBBS [2]
Overview
Surgery is the mainstay of treatment for glomus tumor.
Surgery
- Surgery is the mainstay of treatment for glomus tumor.[1]
- Surgical resection may be performed via several approaches:[2]
- Straightforward excision using a nail bed margin approach[3]
- Trap-door technique[4]
- A technique described by Lee et al designed to conserve the nail plate itself[5]
- Transungual
- The nail plate is removed and an incision is made on the nail bed.
- The nail bed is elevated to expose the tumor adequately for removal.
- It is then followed by extensive repair of the nail bed.
- The transungual approach is the simplest and gives the best exposure of the nail bed.
- Lateral subperiosteal
- An incision is made dorsal to the mid-lateral line.
- Dissection is performed to the distal phalanx and a dorsal flap consisting of skin, nail plate, nail bed and germinal matrix tissue is elevated in a single layer.
- It may have a higher risk of incomplete excision.
- Laterodigital Keyser-Littler approach
- This is a high mid-lateral approach from below the paronychial fold.
- The distal phalangeal ligament (which provides lateral support to the nail matrix and nail plate) is identified and retracted.
- The nail matrix is elevated over the ligament and the dorsal cortex of the distal phalanx, followed by resection of the tumor.
-
![Surgical extraction of a glomus tumor from a fingertip. The tumor is the translucent oblate spheroid in the center of the incision, approximate horizontal dimension is 4 millimeters.[6]](/images/6/6c/Glomus_Tumor_Extraction_Closeup.jpg)
Surgical extraction of a glomus tumor from a fingertip. The tumor is the translucent oblate spheroid in the center of the incision, approximate horizontal dimension is 4 millimeters.[6]
![Surgical extraction of a glomus tumor from a fingertip. The tumor is the translucent oblate spheroid in the center of the incision, approximate horizontal dimension is 4 millimeters.[6]](/index.php/File:Glomus_Tumor_Extraction_Closeup.jpg)
- Removal of subungual glomus tumors has been reported to have recurrence rates of 2-13% (highest reported at 50%) and nail bed deformity rates of 0-19%.
- Some recurrence rates have been reported at 50%.
- Recurrence can be due to incomplete excision or development of a new lesion, with the probability of recurrence of glomus tumors in general being highest for subungual glomus tumors.
References
- ↑ Grover C, Khurana A, Jain R, Rathi V (2013). "Transungual surgical excision of subungual glomus tumour". J Cutan Aesthet Surg. 6 (4): 196–203. doi:10.4103/0974-2077.123401. PMC 3884883. PMID 24470715.
- ↑ Vasisht B, Watson HK, Joseph E, Lionelli GT (2004). "Digital glomus tumors: a 29-year experience with a lateral subperiosteal approach". Plast Reconstr Surg. 114 (6): 1486–9. PMID 15509936.
- ↑ Wang PJ, Zhang Y, Zhao JJ (2013). "Treatment of subungual glomus tumors using the nail bed margin approach". Dermatol Surg. 39 (11): 1689–94. doi:10.1111/dsu.12342. PMID 24118542.
- ↑ Pahwa M, Pahwa P, Kathuria S (2010). "Glomus tumour of the nail bed treated with the 'trap door' technique: a report of two patients". J Dermatolog Treat. 21 (5): 298–300. doi:10.3109/09546630903277610. PMID 20438390.
- ↑ Lee HJ, Kim PT, Kyung HS, Kim HS, Jeon IH (2014). "Nail-preserving excision for subungual glomus tumour of the hand". J Plast Surg Hand Surg. 48 (3): 201–4. doi:10.3109/2000656X.2013.861842. PMID 24256308.
- ↑ Glomus tumor. Wikipedia. https://en.wikipedia.org/wiki/Glomus_tumor Accessed on January 19, 2016