Nail sparing and sub-nail bed approach for the excision of subungual glomus tumors

Abstract

Purpose: The excision of subungual glomus tumors on the distal phalanx may cause nail deformities. Herein, we report our nail-sparing and sub-nail bed approach for the excision of subungual glomus tumors, which enables subungual glomus tumor excision without removal of the nail plate and further allows access to the tumor mass by dissecting beneath the nail bed and germinal matrix to minimize postoperative pain and nail bed injury. Therefore, the present article describes this operative approach and reports surgical outcomes with respect to patient satisfaction, pain, and the final postoperative nail shape.Methods: Thirty-two cases of clinically diagnosed subungual glomus tumors treated with this approach were retrospectively evaluated. Mean pain scores were measured at 1 week postoperatively and at the last follow-up. Patients were asked for their subjective opinion regarding the final nail shape, and their responses were assessed as “satisfied” or “unsatisfied.” The objective results for the final nail shape were graded as “excellent,” “good,” or “poor” by two orthopedic hand surgeons.Results: The mean postoperative pain score (visual analog scale) at 1 week was 1.8. No patients reported pain at the last follow-up. Subjectively, 96.6% of patients were satisfied with the operation. Objectively, the postoperative nail shape was excellent in 9.3% of cases, good in 87.5%, and poor in 3.1%.Conclusion: This approach provides minimal postoperative pain, high patient satisfaction, and favorable cosmetic outcomes with respect to the nail shape by avoiding removal of the nail plate and incision of the nail bed and germinal matrix.

Modified nail folding approach: A novel strategy for the treatment of subungual glomus tumors—A case series study

“… 17 Nam et al. 18 conducted a study involving 32 cases of subungual GTs treated with nail bed incision surgery using horizontal and longitudinal incisions. During the follow‐up, longitudinally oriented grooves/streaks, cracks, and tumor recurrence were observed in some cases.…”

“…During the follow‐up, longitudinally oriented grooves/streaks, cracks, and tumor recurrence were observed in some cases. 18 …”

“…Therefore, the latero-ungual method is recommended, particularly for bulky and diffuse tumors, when employing the nail bed incision approach. 17 Nam et al 18 conducted a study involving 32 cases of subungual GTs treated with nail bed incision surgery using horizontal and longitudinal incisions. During the follow-up, longitudinally oriented grooves/streaks, cracks, and tumor recurrence were observed in some cases.…”

“…During the follow-up, longitudinally oriented grooves/streaks, cracks, and tumor recurrence were observed in some cases. 18 Indeed, the complete nail plate removal technique may carry additional complications, including slow nail regrowth, scar formation, and numbness in the affected finger or toe, resulting in a loss of sensory perceptions such as pain, temperature, touch, and pressure sensations. 19,20 The subungual approach, in addition to the complications mentioned earlier, has also been associated with nail bed injury, which can potentially lead to the spread of the lesion to surrounding tissues.…”