Videos of Surgical Procedures in Dermatology
Ultrasound-Guided, Minimally Invasive Resection of a Digital Glomus Tumor
Extirpación eco-guiada mínimamente invasiva del tumor glómico digital
J. Domínguez-Cruz, A. Ortiz-Prieto
, P. Martín-Carrasco, J. Conejo-Mir
Corresponding author
Servicio de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Domínguez-Cruz, A. Ortiz-Prieto, P. Martín-Carrasco, J. Conejo-Mir" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Domínguez-Cruz" ] 1 => array:4 [ "nombre" => "A." "apellidos" => "Ortiz-Prieto" "email" => array:1 [ 0 => "ale.ortizprieto@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Martín-Carrasco" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Conejo-Mir" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Extirpación eco-guiada mínimamente invasiva del tumor glómico digital" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1651 "Ancho" => 1861 "Tamanyo" => 391358 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Outcome immediately after surgery. B, Ultrasound confirmation of tumor resolution. C, Clinical outcome 2 weeks after surgery. D, Ultrasound confirmation 2 weeks after tumor excision.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">A glomus tumor is a benign vascular tumor derived from neuromyoarterial structures. Up to 80% of these lesions are located in the arms, with subungual sites being particularly frequent.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> These subungual tumors are characterized clinically by intense spontaneous pain or pain on trauma and cold intolerance. Treatment of these lesions is a challenge given the difficulty in preoperative localization of the tumor<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> and complications associated with surgery such as recurrence and nail dystrophy.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Description of the Technique</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 43-year-old woman, who had previously undergone prior surgery for a subungual glomus tumor on the fourth finger of the right hand with the same technique described below, but without preoperative ultrasound, attended the clinic with intense paroxysmal pain. The clinical examination was normal, with no evidence of recurrence of the subungual glomus tumor (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). A skin ultrasound with an 18<span class="elsevierStyleHsp" style=""></span>MHz transducer was performed and tumor recurrence was detected in the nail bed. The tumor measured 3.1<span class="elsevierStyleHsp" style=""></span>mm in diameter (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Prior to surgery, the tumor was localized by ultrasound and the nail plate was marked using a homemade guide (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). For this, the ultrasound transducer was oriented longitudinally with respect to the nail apparatus and the ultrasound guide was introduced perpendicular to the transducer to generate a comet tail reverberation that would hide the tumor (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). At this point, we kept the ultrasound guide fixed, withdrew the transducer, and marked the nail plate (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Subsequently, after peripheral nerve block anesthesia of the finger with mepivacaine 2%, minimally invasive surgery was performed with removal of the nail plate using a 5<span class="elsevierStyleHsp" style=""></span>mm punch, tumor excision with 4<span class="elsevierStyleHsp" style=""></span>mm punch, dissection with a no. 15 scalpel, electrocoagulation of the nail bed, and induction of hemostasis with Gelita and Monsel solution (ferric subsulfate 20%). Histological study confirmed diagnosis of glomus tumor recurrence. The outcome of surgery was favorable. Pain resolved after the procedure and no evidence of tumor persistence was detected by ultrasound (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A-D).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications and Contraindications for the Technique</span><p id="par0020" class="elsevierStylePara elsevierViewall">The technique is suitable for treating subungual glomus tumors of difficult clinical preoperative localization or recurrent tumors. The procedure should be used preferably for small tumors (<<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>mm) with a distal subungual location, thus avoiding the classic transungual approach with a high risk of oncydystrophy.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> This approach is simple and less traumatic. A drawback of the technique to highlight is that the lesion cannot be well visualized during surgery compared with a transungual approach. With this technique, use of preoperative ultrasound and marking the exact site of the tumor on the nail plate with a guide avoided having to perform the surgery blind.</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Complications</span><p id="par0025" class="elsevierStylePara elsevierViewall">The technique we present is very safe and complications are infrequent. Although operative bleeding is limited, it may be appropriate to apply a tourniquet prior to the procedure to enable directed bloodless surgery for complete excision of the lesion.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="par0030" class="elsevierStylePara elsevierViewall">This ultrasound-guided approach is useful for the treatment of recurrent subungual lesions or those that are hard to localize prior to excision.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Surgical excision using a tourniquet, partially extracting the plate with prior orientation of the affected quadrant by an imaging test and an ultrasound-guided procedure as described avoid full excision of the nail plate and damage to the matrix. The patient described had a favorable postoperative outcome for both techniques, with a low risk of complications.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of Interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Introduction" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Description of the Technique" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Indications and Contraindications for the Technique" ] ] ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Complications" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of Interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Domínguez-Cruz J, Ortiz-Prieto A, Martín-Carrasco P, Conejo-Mir J. Extirpación eco-guiada mínimamente invasiva del tumor glómico digital. Actas Dermosifiliogr. 2018;109:271–273.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0050" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0040" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 915 "Ancho" => 1500 "Tamanyo" => 181165 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Normal clinical examination. B, B-mode ultrasound shows a well-defined, solid hypoechoic lesion with an oval form and regular borders measuring 3.1<span class="elsevierStyleHsp" style=""></span>mm in diameter.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1341 "Ancho" => 2133 "Tamanyo" => 221065 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Homemade metallic ultrasound guide. B and C, Use of comet tale reverberation to create an ultrasound guide for preoperative localization.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1651 "Ancho" => 1861 "Tamanyo" => 391358 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Outcome immediately after surgery. B, Ultrasound confirmation of tumor resolution. C, Clinical outcome 2 weeks after surgery. D, Ultrasound confirmation 2 weeks after tumor excision.</p>" ] ] 3 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 198536164 "Video" => array:2 [ "mp4" => array:5 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Claves del diagnóstico y tratamiento del tumor glómico subungueal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 5 | 17 |
| 2024 October | 74 | 45 | 119 |
| 2024 September | 92 | 29 | 121 |
| 2024 August | 117 | 59 | 176 |
| 2024 July | 80 | 28 | 108 |
| 2024 June | 92 | 31 | 123 |
| 2024 May | 65 | 28 | 93 |
| 2024 April | 77 | 27 | 104 |
| 2024 March | 101 | 22 | 123 |
| 2024 February | 87 | 31 | 118 |
| 2024 January | 71 | 27 | 98 |
| 2023 December | 88 | 22 | 110 |
| 2023 November | 93 | 28 | 121 |
| 2023 October | 67 | 19 | 86 |
| 2023 September | 80 | 30 | 110 |
| 2023 August | 46 | 26 | 72 |
| 2023 July | 79 | 31 | 110 |
| 2023 June | 78 | 18 | 96 |
| 2023 May | 70 | 20 | 90 |
| 2023 April | 75 | 27 | 102 |
| 2023 March | 108 | 39 | 147 |
| 2023 February | 78 | 22 | 100 |
| 2023 January | 69 | 32 | 101 |
| 2022 December | 66 | 31 | 97 |
| 2022 November | 56 | 30 | 86 |
| 2022 October | 40 | 23 | 63 |
| 2022 September | 35 | 34 | 69 |
| 2022 August | 49 | 35 | 84 |
| 2022 July | 27 | 35 | 62 |
| 2022 June | 60 | 25 | 85 |
| 2022 May | 81 | 46 | 127 |
| 2022 April | 67 | 49 | 116 |
| 2022 March | 64 | 60 | 124 |
| 2022 February | 59 | 26 | 85 |
| 2022 January | 64 | 40 | 104 |
| 2021 December | 44 | 49 | 93 |
| 2021 November | 72 | 55 | 127 |
| 2021 October | 117 | 62 | 179 |
| 2021 September | 60 | 49 | 109 |
| 2021 August | 49 | 49 | 98 |
| 2021 July | 37 | 45 | 82 |
| 2021 June | 41 | 36 | 77 |
| 2021 May | 52 | 54 | 106 |
| 2021 April | 110 | 91 | 201 |
| 2021 March | 74 | 35 | 109 |
| 2021 February | 66 | 62 | 128 |
| 2021 January | 45 | 53 | 98 |
| 2020 December | 43 | 41 | 84 |
| 2020 November | 47 | 44 | 91 |
| 2020 October | 25 | 30 | 55 |
| 2020 September | 58 | 23 | 81 |
| 2020 August | 31 | 35 | 66 |
| 2020 July | 32 | 24 | 56 |
| 2020 June | 45 | 35 | 80 |
| 2020 May | 16 | 17 | 33 |
| 2020 April | 23 | 18 | 41 |
| 2020 March | 25 | 13 | 38 |
| 2020 February | 9 | 0 | 9 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 8 | 0 | 8 |
| 2019 November | 4 | 0 | 4 |
| 2019 September | 4 | 0 | 4 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 8 | 0 | 8 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 6 | 1 | 7 |
| 2019 April | 2 | 0 | 2 |
| 2019 February | 4 | 0 | 4 |
| 2018 December | 2 | 0 | 2 |
| 2018 November | 5 | 0 | 5 |
| 2018 September | 2 | 0 | 2 |
| 2018 April | 2 | 0 | 2 |
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