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{{Glomus tumor}}
{{Glomus tumor}}
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==Overview==
[[Surgery]] is the mainstay of treatment for glomus [[tumor]]. Surgical [[resection]] may be performed via several approaches including [[Nail beds|nail bed]] margin approach, Trap-door technique, Lee et al's [[nail plate]] conservation, transungal, [[lateral]] [[subperiosteal]], and Laterodigital Keyser-Littler approach.
 
==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>
*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 beds|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>
***Simple
***Feasible
***Low [[Complications|complication]] rate
***Low recurrence rate
***Can sufficiently expose and completely excise [[tumors]] at any subungual region
**'''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'''<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>
***Better [[Nail beds|nail bed]] exposure
***Easier [[Tumour|tumor]] excision
***Less damage to the [[Nail beds|nail bed]]
***Less deformity of the [[Nail (anatomy)|nail]]
**'''Transungual'''<ref name="pmid28978594">{{cite journal| author=Altinel D, Serin M, Leblebici C, Toplu G| title=Transungual resection of subungual glomus tumour. | journal=BMJ Case Rep | year= 2017 | volume= 2017 | issue=  | pages=  | pmid=28978594 | doi=10.1136/bcr-2017-221211 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28978594  }}</ref>
***The [[nail plate]] is removed and an [[incision]] is made on the [[Nail beds|nail bed]].
***The [[Nail beds|nail bed]] is elevated to expose the [[tumor]] adequately for removal.
***It is then followed by extensive repair of the [[Nail beds|nail bed]].
***The transungual approach is the simplest and gives the best exposure of the [[Nail beds|nail bed]].
**'''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.
***[[Dissection (medical)|Dissection]] is performed to the distal [[phalanx]] and a dorsal flap consisting of [[skin]], [[nail plate]], [[Nail beds|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'''<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 [[Paronychia|paronychial]] fold.
***The distal [[Phalanx|phalangeal]] [[ligament]] (which provides lateral support to the [[nail matrix]] and [[nail plate]]) is identified and [[Retraction|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 beds|nail bed]] deformity rates of 0-19%.<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>
* 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]].<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>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 00:13, 24 June 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] Roukoz A. Karam, M.D.[3]

Overview

Surgery is the mainstay of treatment for glomus tumor. Surgical resection may be performed via several approaches including nail bed margin approach, Trap-door technique, Lee et al's nail plate conservation, transungal, lateral subperiosteal, and Laterodigital Keyser-Littler approach.

Surgery

  • 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. Altinel D, Serin M, Leblebici C, Toplu G (2017). "Transungual resection of subungual glomus tumour". BMJ Case Rep. 2017. doi:10.1136/bcr-2017-221211. PMID 28978594.
  7. 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.
  8. 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.