Glomus tumor surgery: Difference between revisions
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***It is then followed by extensive repair of the nail bed. | ***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. | ***The transungual approach is the simplest and gives the best exposure of the nail bed. | ||
**'''Lateral [[subperiosteal]]''' | **'''Lateral [[subperiosteal]]'''<ref name="pmid25957553">{{cite journal| author=Garg B, Machhindra MV, Tiwari V, Shankar V, Kotwal P| title=Nail-preserving modified lateral subperiosteal approach for subungual glomus tumour: a novel surgical approach. | journal=Musculoskelet Surg | year= 2016 | volume= 100 | issue= 1 | pages= 43-8 | pmid=25957553 | doi=10.1007/s12306-015-0374-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25957553 }}</ref> | ||
***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. | ||
Revision as of 21:59, 15 May 2019
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Glomus tumor surgery On the Web |
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American Roentgen Ray Society Images of Glomus tumor surgery |
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[6]
- 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[7]
- 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.[8]](/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.[8]
![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.[8]](/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%.[3]
- 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.[4]
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.
- ↑ 3.0 3.1 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.
- ↑ 4.0 4.1 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.
- ↑ Garg B, Machhindra MV, Tiwari V, Shankar V, Kotwal P (2016). "Nail-preserving modified lateral subperiosteal approach for subungual glomus tumour: a novel surgical approach". Musculoskelet Surg. 100 (1): 43–8. doi:10.1007/s12306-015-0374-z. PMID 25957553.
- ↑ Goubier JN, Le Bellec Y, Cottias P, Ragois P, Alnot JY, Masmejean E (2001). "[Isolated fifth digit localization in Dupuytren's disease]". Chir Main. 20 (3): 212–7. PMID 11496607.
- ↑ Glomus tumor. Wikipedia. https://en.wikipedia.org/wiki/Glomus_tumor Accessed on January 19, 2016