Subungual glomus tumours of the hand: diagnosis and outcome of the transungual approach

2009 ◽  
Vol 34 (5) ◽  
pp. 685-688 ◽  
Author(s):  
I. J. LEE ◽  
D. H. PARK ◽  
M. C. PARK ◽  
N. S. PAE
Keyword(s):  
Local Recurrence ◽  
Severe Pain ◽  
Nail Plate ◽  
Glomus Tumour ◽  
Nail Bed ◽  
Surgical Microscope

We report 17 patients with a subungual glomus tumour. All complained of pain and tenderness when touched, and nine patients experienced severe pain in the cold. A transungual approach with nail plate avulsion on one side was used in all cases. A surgical microscope was used to localise and dissect the tumour and to repair the nail bed and matrix. This method has produced good results, without local recurrence or postoperative nail plate deformity.

scholarly journals Subungual glomus tumour excision: The nail plate flap technique

2017 ◽  
Vol 2 (3) ◽  
Author(s):  
Sandeep Mehrotra ◽  
Vikas Singh ◽  
Uday Singh Dadwal
Keyword(s):  
Nail Plate ◽  
Glomus Tumour ◽  
Nail Bed ◽  
Beneficial Effects ◽  
Flap Technique ◽  
Accurate Localization ◽  
Nail Deformity ◽  
Improved Outcomes ◽  
One Year

<p>Subungual glomus tumours, though rare, cause distressing symptoms and merit surgical treatment with minimal morbidity. Approaches to the nail bed over the years have varied from earlier nail excisions to trans/sub/periungal techniques. Nail plate preservation has beneficial effects on pain, and cosmesis and surgical modifications to ensure the same are desirable. We employed a simple nail preservation technique on six patients over the last seven years. After an accurate localization of the lesion based on pin test and MRI, a proximally-based nail plate flap was marked and elevated beyond the glomus. The tumour was removed through a linear nail-bed incision, following which the nail plate flap was reposited without suturing. All cases had gratifying relief of symptoms. Within a few weeks of the excision, no nail distortion was noticeable. No recurrences were noted on follow-up for one year. The nail flap transungal approach relies on accurate preoperative tumour localization. It ensures a protective post-operative cover with reduced pain. A minimalistic approach with no skin incisions ensures less morbidity and improved cosmesis with no nail deformity. The nail plate flap technique can be employed in selected cases for improved outcomes.</p>

scholarly journals Ultrasound Evaluation of the Effectiveness of the Use of Acitretin in the Treatment of Nail Psoriasis

2021 ◽  
Vol 10 (10) ◽  
pp. 2122
Author(s):  
Magdalena Krajewska-Włodarczyk ◽  
Zbigniew Żuber ◽  
Agnieszka Owczarczyk-Saczonek
Keyword(s):  
Morphological Changes ◽  
Nail Plate ◽  
Clinical Signs ◽  
Extensor Tendon ◽  
Control Group ◽  
Nail Bed ◽  
Nail Psoriasis ◽  
Ultrasound Evaluation ◽  
Tendon Thickness ◽  
Retinoid Treatment

The study aimed to evaluate the effect of retinoid treatment on the morphological changes in the nail apparatus in patients with nail psoriasis. Material and methods: 41 patients aged 32 to 64 with nail psoriasis, without clinical signs of psoriatic arthritis, started on acitretin 0.6 to 0.8 mg kg b.w./d, for six months and 28 people in the control group were included in the study. Both groups had ultrasound examination of fingernails and digital extensor tendon in the distal interphalangeal joints. In psoriatic patients, US examination was conducted before starting the treatment and after six months. A total of 685 nails were examined. Results: After six months of treatment, there was a reduction in the thickness of the nail bed and nail matrix (p = 0.046 and p = 0.031, respectively). The thickness of the nail plates decreased, although it was statistically insignificant (p = 0.059) and it was higher than in the control group (p = 0.034). The reduced severity of clinical nail changes after six months of retinoid treatment did not correlate with the reduction in extensor tendon thickness in any group of patients. Conclusions: In patients with nail psoriasis, acitretin treatment resulted in a rapid decrease in the thickness of the nail bed and matrix, but it did not affect the thickness of the nail plate after six months. There was no effect of acitretin on the digital extensor tendon thickness or the increased blood supply to the tendon area. The results of the study may indicate the usefulness of ultrasound nail examinations in patients with nail psoriasis not only to assess the advancement of morphological changes and response to treatment, but also to choose the potential treatment.

Recurrent Onychomadesis of the Toenails in Children and Adults: A Case Series

2021 ◽  
pp. 1-3
Author(s):  
Dana Sous ◽  
Michela V.R. Starace ◽  
Lu Chen ◽  
Elizabeth L. Nieman ◽  
Milan J. Anadkat ◽  
...  
Keyword(s):  
Risk Factors ◽  
Side Effects ◽  
Treatment Strategy ◽  
Viral Infections ◽  
Nail Plate ◽  
Case Series ◽  
Drug Side Effects ◽  
Case Presentation ◽  
Nail Bed ◽  
Physical Trauma

<b><i>Introduction:</i></b> Onychomadesis occurs when the nail plate separates from the nail matrix and nail bed, eventually leading to shedding of the nail. This condition has been attributed to viral infections, autoimmune disorders, drug side effects, and physical trauma. A subset of patients has a recurrent form of onychomadesis without a clear trigger; this phenomenon is not well characterized in the literature. <b><i>Case Presentation:</i></b> We present a case series of pediatric and adult patients with recurrent toenail onychomadesis in order to better characterize the disorder and explore possible etiologies, risk factors, and treatments. <b><i>Discussion/Conclusion:</i></b> For the cases herein, we propose microtrauma associated with footwear as the underlying etiology given the periodicity of nail shedding, exclusion of other etiological factors, and presence of predisposing risk factors in certain patients. Many patients saw improvement with application of urea 40% cream, suggesting this can be a valuable part of a treatment strategy, in addition to minimizing injury to involved digits.

scholarly journals Ciclopirox and Efinaconazole Transungual Permeation, Antifungal Activity, and Proficiency To Induce Resistance in Trichophyton rubrum

2019 ◽  
Vol 63 (10) ◽  
Author(s):  
Daniela Monti ◽  
Diletta Mazzantini ◽  
Silvia Tampucci ◽  
Alessandra Vecchione ◽  
Francesco Celandroni ◽  
...  
Keyword(s):  
Antifungal Activity ◽  
Trichophyton Rubrum ◽  
Nail Plate ◽  
Content Type ◽  
Nail Bed ◽  
Antimycotic Activity ◽  
Frequent Relapses ◽  
Induce Resistance ◽  
Over Time

ABSTRACT Onychomycosis is a nail fungal infection, mostly caused by dermatophytes. The treatment efficacy is impaired by difficulties of reaching effective drug levels at the site of infection; frequent relapses occur after cessation of antifungal therapy. The aim of the study was to compare two commercial products containing ciclopirox or efinaconazole for antimycotic activity and antifungal drug resistance. A study of permeation and penetration through bovine hoof membranes, as a nail model, was performed to evaluate the antimycotic activity of permeates against clinical isolates of selected fungi, and the frequency of spontaneous in vitro Trichophyton rubrum-resistant strains was assessed by broth microdilution assays. The results suggest that ciclopirox creates a depot in the nail, leading to a gradual release of the drug over time with action on both the nail plate and bed. Conversely, efinaconazole, mildly interacting with nail keratin, mainly exerts its antifungal activity in the nail bed. However, in the case of T. rubrum, the antifungal activities of the drugs in the nail plate seem comparable. Finally, efinaconazole showed a potential for induction of resistance in T. rubrum, which may limit its efficacy over time. Ciclopirox did not show any potential to induce resistance in T. rubrum and appears endowed with a more complete activity than efinaconazole in the management of onychomycosis as the nail keratin is a substrate for the growth of fungal cells, and the availability of drug in large concentration just in the nail bed may not be sufficient to guarantee the complete eradication of pathogens.

Human nail bed‐derived decellularized scaffold regulates mesenchymal stem cells for nail plate regeneration

2019 ◽  
Vol 13 (10) ◽  
pp. 1770-1778 ◽  
Author(s):  
Yaling Yu ◽  
Haomin Cui ◽  
Demin Zhang ◽  
Bo Liang ◽  
Yimin Chai ◽  
...  
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Nail Plate ◽  
Nail Bed ◽  
Human Nail ◽  
Decellularized Scaffold

Glomus tumour of the nail bed treated with the ‘trap door’ technique: A report of two patients

2010 ◽  
Vol 21 (5) ◽  
pp. 298-300 ◽  
Author(s):  
Manish Pahwa ◽  
Pooja Pahwa ◽  
Susruta Kathuria
Keyword(s):  
Glomus Tumour ◽  
Nail Bed ◽  
Trap Door

Operative Treatment of the Ingrown Toenail With a Less-Invasive Technique: Flashback to the Original Winograd Technique

2017 ◽  
Vol 11 (2) ◽  
pp. 138-141 ◽  
Author(s):  
Yalkin Camurcu ◽  
Hakan Sofu ◽  
Ahmet Issin ◽  
Nizamettin Kockara ◽  
Hakan Saygili
Keyword(s):  
Nail Plate ◽  
Case Series ◽  
Operation Time ◽  
Invasive Technique ◽  
Nail Bed ◽  
Less Invasive ◽  
Ingrown Toenail ◽  
Case Series Study ◽  
Stage 1

Objective: The aim of this study was to evaluate the results of the partial nail plate excision and curettage of nail bed and matrix (the original Winograd technique) in patients with ingrown toenail. Materials and methods:Patients with ingrown toenail who were treated surgically from May 2014 to June 2015, with a minimum follow-up of 1 year were included in this study. Those who had previous ingrown toenail surgery were excluded. Partial nail plate excision with curettage of nail bed and nail matrix was performed for all patients. Rifampicin soaked sterile gauze was placed onto the wounds after the procedure. Results:The study population included 100 males and 89 females with a mean age of 30 years. Eight patients (4.2%) had stage 1, 71 patients (37.6%) had stage 2, and 110 patients (58.2%) had stage 3 ingrown toenails. The mean operation time was 4.8 minutes. No complication occurred during the procedure. It was found that 15 patients (7.9%) had recurrence during the follow-up. Conclusion:The original Winograd technique is an efficient and less-invasive technique for the treatment of ingrown toenail, with lower rates of recurrence and complications. Levels of Evidence: Therapeutic Case Series Study, Level IV

A MODIFIED PERIUNGUAL APPROACH FOR TREATMENT OF SUBUNGUAL GLOMUS TUMOUR

Hand Surgery ◽  
2007 ◽  
Vol 12 (03) ◽  
pp. 217-221 ◽  
Author(s):  
S. T. Fong ◽  
Y. L. Lam ◽  
Y. C. So
Keyword(s):  
Surgical Excision ◽  
Glomus Tumour ◽  
Complete Excision ◽  
Nail Bed ◽  
Peripheral Lesion ◽  
Nail Deformity ◽  
Complete Surgical Excision ◽  
Central Lesions

Subungal glomus tumours are uncommon; the only treatment is complete surgical excision. Transungual approach is often preferred; however, secondary nail deformity may occur. Lateral periungual approach is used to avoid this complication, but this approach provides limited exposure and is used for peripheral lesion only. We describe a modified periungual approach which can be applied to central lesions. This approach can provide adequate exposure for complete excision of the subungual tumour while avoiding incision of the nail bed.

Melanonychia Following Mohs Surgery for Recurrent Squamous Cell Carcinoma in Situ of the Nail Bed

2008 ◽  
Vol 12 (4) ◽  
pp. 194-197 ◽  
Author(s):  
Jules B. Lipoff ◽  
Alon Scope ◽  
Klaus J. Busam ◽  
Kishwer S. Nehal
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Carcinoma In Situ ◽  
Nail Plate ◽  
Diagnostic Dilemma ◽  
Mohs Surgery ◽  
Nail Bed ◽  
Recurrent Squamous Cell Carcinoma

Background: Longitudinal melanonychia (LM) is characterized by the appearance of a longitudinal pigmented band in the nail plate. Melanonychia can occur from many causes, including racial predisposition, trauma, drugs, pregnancy, Addison disease, Peutz-Jeghers syndrome, Laugier-Hunziker syndrome, Bowen disease, onychomycosis, benign nail matrix nevi, and melanoma. Objective: We present a case of diffuse melanonychia developing several months following Mohs surgery for a human papillomavirus-induced recurrent squamous cell carcinoma in situ of the nail bed. Conclusions: This case illustrates the diagnostic dilemma in determining the etiology of the melanonychia and considers the differential diagnosis.

scholarly journals Ultrasound Assessment of Changes in Nails in Psoriasis and Psoriatic Arthritis

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Magdalena Krajewska-Włodarczyk ◽  
Agnieszka Owczarczyk-Saczonek ◽  
Waldemar Placek ◽  
Maja Wojtkiewicz ◽  
Andrzej Wiktorowicz ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Ultrasound Examination ◽  
Morphological Changes ◽  
Nail Plate ◽  
Control Group ◽  
Dorsal Plate ◽  
Nail Bed ◽  
The Matrix ◽  
Group A ◽  
Ultrasound Assessment

Aim of the Study. The aim of the study was to conduct an ultrasound (US) assessment of changes in fingernails in psoriatic patients with nail involvement. Material. A total of 69 patients with psoriatic changes in nails participated in the study, including 38 patients with psoriasis (Ps) and 31 with psoriatic arthritis (PsA) and 30 people in the control group. A total of 988 nails were examined. Results. The thickness of the nail plate, nail bed, and matrix as shown in an ultrasound examination increased with the mNAPSI index (r=0.328, p=0.021; r=0.219, p=0.036; and r=0.422, p=0.011, respectively). The thickness of nail plate, bed, and matrix in patients with onycholysis and hyperkeratosis-type changes (concomitant or present separately) was significantly greater than when only pitting-type changes occurred (p=0.007, p=0.035, and p=0.023, respectively). An examination of nails with only pitting-type changes showed an increase in the matrix thickness compared to the control group (p=0.018). The focal hyperechoic involvement of the dorsal plate (80%) was the change most often observed in an US examination in Ps patients, whereas loosening of the borders of the ventral plate was most often observed in PsA patients. The thickness of nail bed in PsA patients increased with the duration of arthritis (r=0.399, p=0.022) and was correlated with the number of swollen digits (r=0.278, p=0.041). Conclusions. The findings of this study may indicate an association of an inflammation in the nail bed with PsA development. Apart from a direct assessment of the described morphological changes of nails, a US examination could prove useful in an assessment of intensity of a local inflammation as a prognostic factor for PsA development.

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