Glomus tumor surgery: Difference between revisions
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==Surgery== | ==Surgery== | ||
*[[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 | *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''' | |||
**'''Trap-door technique''' | |||
**A technique described by Lee et al designed to '''conserve the nail plate itself''' | |||
**'''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. | ||
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***An incision is made dorsal to the mid-lateral line. | ***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. | ***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''' | **'''Laterodigital Keyser-Littler approach''' | ||
***This is a high mid-lateral approach from below the paronychial fold. | ***This is a high mid-lateral approach from below the paronychial fold. | ||
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Image: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.<ref>Glomus tumor. Wikipedia. https://en.wikipedia.org/wiki/Glomus_tumor Accessed on January 19, 2016</ref> | Image: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.<ref>Glomus tumor. Wikipedia. https://en.wikipedia.org/wiki/Glomus_tumor Accessed on January 19, 2016</ref> | ||
</gallery> | </gallery> | ||
* 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== | ==References== | ||
Revision as of 22:35, 14 May 2019
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Glomus tumor surgery On the Web |
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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
- Trap-door technique
- A technique described by Lee et al designed to conserve the nail plate itself
- 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.[3]](/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.[3]
![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.[3]](/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.
- ↑ Glomus tumor. Wikipedia. https://en.wikipedia.org/wiki/Glomus_tumor Accessed on January 19, 2016