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Handchir Mikrochir Plast Chir 2020; 52(03): 202-206
DOI: 10.1055/a-1170-6209
Originalarbeit

Glomus tumors of the nail bed: topographic anatomy and an algorithmic approach based on the topography

Glomustumoren des Nagelbettes: Lokalisation der Tumoren und Algorithmus für den chirurgischen Zugang abhängig von der Lokalisation
Osman Civan 
1   Department of Orthopedics, Akdeniz University Faculty of Medicine, Antalya, Turkey
,
Özgün Barış Güntürk
2   EMOT Hospital, İzmir, Turkey
,
Kemal Özaksar
2   EMOT Hospital, İzmir, Turkey
,
Ali Cavit
3   Uludag University Faculty of Medicine, Department of Orthopedics & Traumatology, Bursa, Turkey
,
Haluk Özcanli
1   Department of Orthopedics, Akdeniz University Faculty of Medicine, Antalya, Turkey
› Author Affiliations
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. There are no disclosures to declare. Conflict of interest statement. The Authors declare that there is no conflict of interest. Ethics committee approved the study.
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Abstract

Purpose Glomus tumors are rare vascular pathologies characterized by a triad of symptoms: tenderness, pain and cold intolerance. In the hand they are highly concentrated under the nail bed. In this retrospective study, we aimed to present a topographic map of the location of glomus tumors in the nail bed and a map-based surgical approach algorithm to the subungual glomus tumors.

Methods We prepared a nail bed map with 6 zones and named these zones as ulnar distal, ulnar proximal, central distal, central proximal, radial distal and radial proximal. With respect to the tumor location and the used surgical approach we retrospectively evaluated the intraoperative photos and the hospital records of patients who were operated between 2008–2019 and had the pathological diagnosis of glomus tumor. The examination records of the postoperative first year were evaluated for each patient retrospectively. A descriptive statistical analysis was performed. In addition we analyzed the described surgical approaches to excise a glomus tumor in the nail bed. The described approaches and the approaches used by us were matched with the localisation of the tumors in this study developing an algorithm for the surgical approach depending on the localisation of the nail bed glomus tumor.

Results Finally 44 patients had inclusion criteria. The distribution of the glomus tumor was as follows: 2 were on ulnar distal (4.5 %), 9 on ulnar proximal (20.5 %), 1 on central distal (2.3 %), 18 on central proximal (40.9 %), 4 on radial distal (9.1 %) and 10 were on the radial proximal zones (22.7 %). 4 lateral approaches, 1 nail sparing and 39 transungual approaches were performed. We had one recurrence in a male patient operated by transungual approach.

Conclusion Glomus tumors are mostly located on the central proximal part of the nail bed. Our glomus map and the algorithm we described might be helpful for the selection of the surgical approach for the glomus tumor.

Zusammenfassung

Ziel Glomustumoren sind seltene vaskuläre Tumoren ausgehend von Glomuskörperchen. Die klinische Symptomatik ist gekennzeichnet durch: Berührungsempfindlichkeit, Schmerzen und Kälteintoleranz. An der Hand sind Glomustumoren häufig unter dem Nagelbett lokalisiert. In dieser retrospektiven Studie haben wir die Lokalisation von Glomustumoren des Nagelbettes analysiert und darauf basierend einen Algorithmus für den chirurgischen Zugang zur Exzision entwickelt.

Methoden Das Nagelbett wurde in 6 Zonen unterteilt: ulnar-distal, ulnar-proximal, zentral-distal, zentral-proximal, radial-distal und radial-proximal. Retrospektiv wurden die Krankenakte und die intraoperativen Fotos von 44 Patienten, die zwischen 2008 und 2019 bei histologisch gesicherter Diagnose eines Glomustumors des Nagelbettes operiert wurden, im Hinblick auf die Tumorlokalisation und den verwendeten Zugang ausgewertet. Des Weiteren wurden die Nachuntersuchungsergebnisse ein Jahr postoperativ ausgewertet und eine deskriptive Statistik durchgeführt. Die in der Literatur beschriebenen chirurgischen Zugänge zur Exzision eines Glomustumors des Nagelbettes wurden erfasst. Unter Berücksichtigung der beschrieben Zugänge und der von uns verwendeten Zugänge wurde unter Berücksichtigung der in dieser Untersuchung gefundenen Lokalisationen der Glomustumoren ein Algorithmus für den chirurgischen Zugang abhängig von der Tumorlokalisation entwickelt.

Ergebnisse Die Verteilung der Glomustumoren war wie folgt: 2 fanden sich ulnar-distal (4,5 %), 9 ulnar-proximal (20,5 %), 1 zentral-distal (2,3 %), 18 zentral-proximal (40,9 %), 4 radial-distal (9,1 %) und 10 radial-proximal (22,7 %). Es wurden 4 laterale, 1 nagelschonender und 39 transunguale Zugänge verwendet. Nach einem Jahr fand sich ein Rezidiv bei einem Mann, der transungual operiert wurde.

Schlussfolgerungen Glomustumoren des Nagelbettes finden sich meist im zentralen proximalen Teil des Nagelbettes. Der die Lokalisation der Tumoren berücksichtigende Algorithmus für den chirurgischen Zugang möge bei der Wahl des Zugangs zur Exzision von Glomustumoren des Nagelbettes hilfreich sein.

Key words

Glomus tumors - nail bed - surgical approach

Schlüsselwörter

Glomustumoren - Nagelbett - chirurgischer Zugang


Publication History

Received: 01 March 2020

Accepted: 29 April 2020

Article published online:
12 June 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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