Nail-preserving excision for subungual glomus tumour of the hand

Abstract

Subungual glomus tumours can cause excruciating pain and nail deformity. Conventional surgical excision requires nail removal and, therefore, nail deformity often occurs. Because nail preservation prevents further damage to the nail bed, it is beneficial for patients from the perspectives of pain and cosmesis. Here, the authors introduce a nail-preserving transungual approach for subungual glomus tumours. Between 1996–2010, 34 patients were treated using this nail-preserving transungual approach for the excision of a subungual glomus tumour and were followed up. Preoperatively, all patients complained of pain (mean visual analogue scale (VAS) 8.9), and seven of the 34 patients presented concomitant nail deformities. During surgeries, nails were elevated after incising nail folds, and tumours were excised after a longitudinal nail bed incision. Elevated nails were relocated to their original position after nail bed repair. Thirty-two of the 34 patients achieved complete recovery without sign of recurrence. Mean postoperative pain was reduced (VAS 0.9, range = 0–2), and preoperative nail deformity was also improved. The nail preserving transungual approach provides several advantages, that is, better nail bed exposure, resulting in easier tumour excision, and less damage to the nail bed with less deformity of the nail.