The ‘shark mouth’ flap approach for digital glomus tumours in 24 patients: technique and clinical outcomes

Asmar, G.; Mati, Tahar; Pop, Ioana; Falcone, M.-O.

doi:10.1177/1753193419867049

Cited by 5 publications

(5 citation statements)

References 18 publications

(23 reference statements)

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“…It provides ideal exposure, easy access and combines the advantages of both trans-ungual and lateral approaches, whether the subungual tumors are located centrally, peripherally or under the germinal matrix. 17 Recurrence rates in digital glomus tumor vary from 1% to 50% in various studies. 1,2,7,11,[18][19][20] Incomplete surgical excision is the most common cause especially in early recurrence within days to weeks.…”

Section: Discussionmentioning

confidence: 99%

“…A subperiosteal approach with a ‘shark mouth’ flap containing the nail plate and nail bed as a single unit has been described recently. It provides ideal exposure, easy access and combines the advantages of both trans‐ungual and lateral approaches, whether the subungual tumors are located centrally, peripherally or under the germinal matrix 17 …”

Section: Discussionmentioning

confidence: 99%

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Clinico‐epidemiological profile and management outcome of subungual digital glomus tumor—Indian experience

Singal

Bisherwal

Agrawal

et al. 2022

Dermatologic Therapy

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Background: Glomus tumors are rare tumors arising from the mesenchymal smooth muscle cells of the glomus body. They are extremely painful tumors but because of their subungual location, remain mostly underdiagnosed.Aim: To characterize the demographic, clinical, onychoscopic, radiological features and management outcome of subungual glomus tumor. Material & methods-15 patients with a total of 16 subungual glomus tumors were evaluated and their demographic data, history, clinical features, investigations, treatment, and follow-up were analyzed.Results: Glomus tumors had a female preponderance (11/15) with thumb being the commonest site. All patients presented with intractable pain. Nail discoloration was observed in 11/16 (68.8%) lesions and nail plate deformity in 6/16 (37.5%) lesions.Common features on onychosocpy were pink glow and linear vascular structures. Doppler sonography and/or magnetic resonance imaging confirmed the diagnosis of glomus tumor in all the lesions. Surgical excision was done under local anesthesia using a trans-ungual approach and no recurrence was seen.Conclusions: High index of suspicion, meticulous clinical assessment along with radiological investigations can help in the early diagnosis. Complete surgical excision is the treatment of choice to prevent recurrence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinico‐epidemiological profile and management outcome of subungual digital glomus tumor—Indian experience

Singal

Bisherwal

Agrawal

et al. 2022

Dermatologic Therapy

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“…Although this approach provides a good view, it has been stated that this may promote aesthetic problems such as split nails. For this reason, lateral periungual incisions or those performed through a window opened on the tumour at the nail plate have been described [13,20,21]. It has been suggested that the incision type should be determined according to the location of the glomus tumour.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Subungual Glomus Tumours in Terms of Nail Aesthetics and Recurrence According to Size and Location in the Germinal or Sterile Matrix

Orman

Önal

Baydar

et al. 2022

Handchir Mikrochir Plast Chir

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Purpose The aim of this retrospective study was to investigate the effect of subungual glomus tumour size and localization in the germinal or sterile matrix on tumour recurrence and aesthetic outcomes. Patients and Methods From 35 patients who underwent surgery for a subungual glomus tumour between February 2013 and February 2020, 26 patients – 17 women and 9 men – with 27 subungual glomus tumours fulfilled the inclusion criteria. The average age was 37.3 (22–58) years. According to the patients’ surgical notes and preoperative magnetic resonance images 14 tumours were located in the sterile, 13 in the germinal matrix, and the mean size of the glomus tumours located in the germinal matrix was 4.9±1.7 mm, in the sterile matrix 3.6±1.0 mm. At the postoperative 12th month follow-up visit nail aesthetic was evaluated objectively according to Zook’s fingernail appearance scoring. In addition, patients were asked to evaluate the pain and nail appearance in the involved finger by VAS (Visual Analog Scale 0–10). Patients who experienced recurrence were noted. Results No significant Zook’s fingernail appearance score differences were observed between germinal and sterile matrix groups (p=0.097). Comparison of VAS score for pain and VAS score for nail appearance between the two groups also yielded similar values (p=0.449 and 0.395, respectively). The recurrence rate was similar at both locations (p=0.557) with 3 recurrences in the germinal, and 2 in the sterile matrix group. There was no relation between tumour size, Zook’s fingernail appearance score (p=0.874) and recurrence (p=0.784). The observed germinal matrix glomus tumours were significantly larger than the sterile matrix tumours (p=0.031). Conclusion Neither subungual glomus tumour size nor localization in the germinal or sterile matrices has different effects on nail appearance and recurrence.

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“…The most common approach is the transungual approach. This approach provides a good exposure but has some disadvantages like nail deformities [1,6,[18][19][20]. To reduce the complications due to the used approach we prepared a map of the locations of glomus tumors in the nail bed and developed an algorithm for the choice of the surgical approach depending on the lo-cation of the tumor (▶ Fig.…”

Section: Discussionmentioning

confidence: 99%

“…For the shark mouth flap incision (SMFI) good results were reported in the literature [18]. This incision can be used for all zones.…”

Section: Discussionmentioning

confidence: 99%

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

Ci̇van

Ozaksar²,

Cavit

et al. 2020

Handchir Mikrochir Plast Chir

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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.

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The ‘shark mouth’ flap approach for digital glomus tumours in 24 patients: technique and clinical outcomes

Cited by 5 publications

References 18 publications

Clinico‐epidemiological profile and management outcome of subungual digital glomus tumor—Indian experience

Clinico‐epidemiological profile and management outcome of subungual digital glomus tumor—Indian experience

Comparison of Subungual Glomus Tumours in Terms of Nail Aesthetics and Recurrence According to Size and Location in the Germinal or Sterile Matrix

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

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