Glomus tumor surgery: Difference between revisions
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==Overview== | ==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]] 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== | ||
*[[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'''<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> | **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 | ***Simple | ||
***Feasible | ***Feasible | ||
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***Can sufficiently expose and completely excise [[tumors]] at any subungual region | ***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> | **'''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> | **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 | ***Better [[Nail beds|nail bed]] exposure | ||
***Easier [[Tumour|tumor]] excision | ***Easier [[Tumour|tumor]] excision | ||
***Less damage to the nail bed | ***Less damage to the [[Nail beds|nail bed]] | ||
***Less deformity of the [[Nail (anatomy)|nail]] | ***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> | **'''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 bed. | ***The [[nail plate]] is removed and an [[incision]] is made on the [[Nail beds|nail bed]]. | ||
***The nail bed is elevated to expose the tumor adequately for removal. | ***The [[Nail beds|nail bed]] is elevated to expose the [[tumor]] adequately for removal. | ||
***It is then followed by extensive repair of the nail bed. | ***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 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> | **'''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 beds|nail bed]] and [[germinal matrix]] tissue is elevated in a single layer. | ***[[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]]. | ***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> | **'''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 [[Paronychia|paronychial]] fold. | ||
***The distal [[Phalanx|phalangeal]] [[ligament]] (which provides lateral support to the nail matrix and nail plate) is identified and retracted. | ***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. | ***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%.<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> | * 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%. | * 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> | * 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== | ||
Latest revision as of 00:13, 24 June 2019
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Glomus tumor Microchapters |
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Treatment |
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Case Studies |
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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] 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
- 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]
- Simple
- Feasible
- Low complication rate
- Low recurrence rate
- Can sufficiently expose and completely excise tumors at any subungual region
- Trap-door technique[4]
- A technique described by Lee et al designed to conserve the nail plate itself[5]
- Transungual[6]
- Lateral subperiosteal[7]
- 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[8]
- 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.
- Straightforward excision using a nail bed margin approach[3]
- 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.
- ↑ 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.
- ↑ 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.