Glomus tumor surgery: Difference between revisions

Jump to navigation Jump to search
No edit summary
Line 21: Line 21:
***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.   
***It may have a higher risk of incomplete excision.   
**'''Laterodigital Keyser-Littler approach'''
**'''Laterodigital Keyser-Littler approach'''<ref name="pmid11496607">{{cite journal| author=Goubier JN, Le Bellec Y, Cottias P, Ragois P, Alnot JY, Masmejean E| title=[Isolated fifth digit localization in Dupuytren's disease]. | journal=Chir Main | year= 2001 | volume= 20 | issue= 3 | pages= 212-7 | pmid=11496607 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11496607  }}</ref>
***This is a high mid-lateral approach from below the paronychial fold.  
***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 distal phalangeal [[ligament]] (which provides lateral support to the nail matrix and nail plate) is identified and retracted.  

Revision as of 21:58, 15 May 2019

Glomus tumor Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Glomus tumor from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Glomus tumor surgery On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Glomus tumor surgery

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Glomus tumor surgery

CDC on Glomus tumor surgery

Glomus tumor surgery in the news

Blogs on Glomus tumor surgery

Directions to Hospitals Treating Glomus tumor

Risk calculators and risk factors for 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
      • 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[6]
      • 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.
  • 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

  1. 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.
  2. 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. 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. 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.
  5. 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.
  6. 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.
  7. Glomus tumor. Wikipedia. https://en.wikipedia.org/wiki/Glomus_tumor Accessed on January 19, 2016