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American Association for Hand Surgery

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Nail Sparing and Sub-nail bed Approach to Subungual Glomus Tumors
Jae Jun Nam, M.D.1, Yong Been Kim, M.D.1, In Cheul Choi, MD, PhD2 and Jong Woong Park, Professor, MD, PhD1, (1)Korea University Anam Hospital, Seoul, Korea, Republic of (South), (2)Korea University Medicine Anam Hospital, Seoul, Korea, Republic of (South)

Background:
Subungual glomus tumors are known to cause pain and frequent nail deformities after surgical removal. Conventional surgical excision of the tumor requires complete or partial removal of the nail plate to expose the nail bed and tumor which subsequently results in nail deformities or other complications such as incomplete removal or infection. Here, we report on "antegrade sub-nailbed approach to subungual glomus tumors" which enables tumor excisions without the removal of the nail plate and access to the tumor mass through dissection beneath the nail bed and germinal matrix, resulting in less nail deformities after the operation.
Objective:
The purpose of this study was to report on a novel operative method of antegrade sub-nailbed approach to subungual glomus tumors, and to report on its improved cosmetic outcome with respect to nail deformities and fewer surgical complications after surgery.
Methods & Materials:
Between June 2006 to May 2021, 29 patients (32 cases) were treated using this operation technique (Figure 1.) The subjective and objective results about the final nail deformities were evaluated according to our grading system with respect to the final nail deformity (excellent; significant postoperative improvement, good; no change, fair; preoperative deformity remained at follow-up, poor; worsening of the deformity or newly developed deformity at follow-up).
Results:
Subjectively, 96.6% of patients reported the outcome of the surgery as "good" and were highly satisfied with the cosmetic result. Objective cosmetic outcome analysis was performed by two orthopedic hand surgeons and revealed that 9.3% of cases exhibited ‘excellent' result with significant improvement in the nail deformities, 59.4% was "good", 28.1% was "fair", and 3.1% (n = 1) demonstrated worsening of the nail shape.
Conclusion:
This operation method provides several advantages over many of the previously reported techniques with improved cosmetic outcomes as well as fewer surgical complications due to the complete preservation of the nail plate and no direct incision to the nail bed and germinal matrix.


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