Application of distal arc-shaped incision of lunula combined with nail template replantation in the treatment of subungual glomus tumor
10.3760/cma.j.cn114453-20220726-00234
- VernacularTitle:甲弧影以远弧形切口联合甲模板回植在治疗甲下血管球瘤中的应用
- Author:
Weijian CHEN
1
;
Bin LIU
;
Liang LU
;
Jianxue ZENG
;
Duoyu LI
Author Information
1. 中国科学技术大学附属第一医院(安徽省立医院)骨科，合肥 230001
- Keywords:
Glomus tumor;
Nails;
Nail Diseases;
Nail bed;
lunula;
Nail template
- From:
Chinese Journal of Plastic Surgery
2023;39(3):266-272
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the feasibility and efficacy of distal arc-shaped incision of lunula combined with nail template replantation for the treatment of subungual glomus tumor.Methods:The clinical data with subungual glomus tumor treated in the Department of Orthopedics of First Affiliated Hospital of the University of Science and Technology of China from March 2019 to June 2021 were retrospectively analyzed. Each patient removed the nail, the nail bed was cut into by a distal arc-shaped incision of the lunula. After the tumor was exposed, the tumor was resected completely, the nail bed flap was reduced in situ without suturing. The nail template was made by using the 5 ml syringe barrel or the original nail and poked the drainage holes in it, then the nail template was covered on the nail bed surface, three-point suturing and pressurized fixation, routine dressing change, and the nail template was removed 3 weeks after the procedure. The visual analogue scale (VAS) of pain was recorded preoperative and one month after the operation, and nail bed healing, pain improvement, nail growth, and tumor recurrence were observed. VAS scores before and after surgery were expressed as M( Q1, Q3), and analyzed by Mann-Whitney U test, P<0.05 was considered statistically significant. Results:A total of 37 patients were enrolled, including 5 males and 32 females. The age ranged from 18 to 67 years old, with an average of 39 years old. All patients were confirmed as subungual glomus tumors by postoperative pathology, they were followed up for 6 to 36 months, with an average of 22 months. All of the patients had no obvious pain during the dressing change, after removing the nail template, the nail bed was flat and dry, and no obvious scar formation was found. All postoperative incisions were healed in one stage, the new nail recovered smoothly with a satisfactory appearance, the pain symptoms disappeared completely, and also no recurrence occurred during follow-up. The preoperative VAS score was 5.0 (4.5, 6.0), the VAS score one month after the operation was 0.0 (0.0, 0.0), and the difference was statistically significant ( Z=-7.57, P<0.001). Conclusion:The distal arc-shaped incision of the lunula for the treatment of subungual glomus tumor can effectively protect the germinal matrix of the nail bed, with sufficient tumor exposure, complete resection, and low recurrence rate. At the same time, combined with nail template replantation can significantly reduce nail bed scar formation and effectively prevent postoperative nail deformity. The method is simple, easy to operate, and has significant clinical efficacy.
