Subungual exostosis – treatment results with preservation of the nail bed

Pascoal, Diogo; Balacó, Inês; Alves, Cristina; Cardoso, Pedro; Ling, Tah Pu; Matos, Gabriel

doi:10.1097/bpb.0000000000000723

Cited by 8 publications

(2 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is worth noting that the prior use of magnetic resonance imaging is described as a means for conducting differential diagnoses. Clinical assessment and focused interviews are crucial for accurate diagnosis and timely surgical decision-making since complete marginal excision of the exostosis appears to minimize recurrence [13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Infrequent Pediatric Subungual Injury Diagnosed by Intraoperative Anatomopathological Material: A Case Report

Navarro Vergara,

Navarro Fretes,

Medina Villate

2024

Cureus

View full text Add to dashboard Cite

Subungual lesions are very common in clinical practice. We present the clinical case of a 10-year-old female patient who presented with progressive nail deformity. The onset of the condition was approximately five years prior to presentation with an injury in the left hallux, according to the mother. She denied pain or change in the color of the area from the onset of the injury to the day of consultation. There was no previous trauma. Examination revealed subungual bone injury to the distal extremity (distal phalanx of the left hallux), and imaging tests (X-ray and soft tissue ultrasound) found bone injury. Subungual exostosis was considered as a possible diagnosis, thus prompting the indication for exeresis of the tumoral process. After surgical removal, the resected specimen was sent for pathological assessment, which found that an intraosseous hemangiolymphangioma was the origin of the tumor. A subungual exostosis is a slow-growth benign osseous tumor mainly located in the distal phalanx of the hallux that especially affects young adults, being less frequent in children. This condition results from a process of bone neoformation involving different stages, the clinical symptoms of which depend on its size and associated processes. Hemangiolymphangiomas are angiomatous lesions of the blood and lymphatic vessels that have a controversial etiology and present slow, painless, and progressive growth; these lesions are mostly benign. It is worth emphasizing that subungual injuries are not always caused by an underlying bone; therefore, potential differential diagnoses, both benign and malignant, should be considered, based on the location of the injury.

show abstract

Section: Discussionmentioning

confidence: 99%

Infrequent Pediatric Subungual Injury Diagnosed by Intraoperative Anatomopathological Material: A Case Report

Navarro Vergara,

Navarro Fretes,

Medina Villate

2024

Cureus

View full text Add to dashboard Cite

show abstract

“…The principles of tumor surgery must be respected in their excision. Therefore, and also taking into account that the main complications of subungual exostosis resection are nail matrix damage, infection and tumor recurrence [8] the basic principles for a successful resection of subungual exostosis should be the least possible soft tissue damage, preservation of the nail matrix, and adequate debridement of the implantation bed sufficient to avoid recurrence and complications.…”

Section: Discussionmentioning

confidence: 99%

Subungual Exostosis of the Hallux: A Solution Through Percutaneous Surgery

Estuardo¹,

Isabel²,

Arturo³

et al. 2023

Act Scie Ortho

View full text Add to dashboard Cite

Background: Subungual exostosis of the hallux is an osteochondral tumor that causes pain and deformity, requiring surgical resection in many cases. Although several specialities treat this tumor, orthopaedic surgeons seem to be poorly versed in its management.Several removal techniques have been described, all of which are open, aggressive and with high complication rates. We present a percutaneous removal technique with minimal soft tissue injury and a low complication rate. Surgical technique: 12-year-old male presented with a painful exostosis of the hallux with severe deformity. Percutaneous forefoot surgery was used to marginally resect the lesion preserving the integrity of the nail matrix. With millimetric wounds, the tumor is detached from its bed, its base was resected and burned. The patient had no complications, unpainful recovery and no recurrences within two years.Discussion: Multiple techniques have been described for the removal of this exostosis. The main difference between them is the way the wound is closed, ranging from healing by secondary intention to direct suturing between the skin and the nail. The complication rate is 40%, the most frequent being residual nail deformity, infection and recurrence. Our technique applies percutaneous surgery, performing minimal damage to the soft tissue and nail bed while achieving the marginal excision of the tumor with debridement of the implantation bed. Conclusion:The excision of the subungual exostosis of the hallux can be performed safely and with a low complication rate through percutaneous surgery, ensuring minimal incisions with little soft tissue damage.

show abstract