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
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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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 13 | 5 | 18 |
| 2024 Octubre | 74 | 45 | 119 |
| 2024 Septiembre | 92 | 29 | 121 |
| 2024 Agosto | 117 | 59 | 176 |
| 2024 Julio | 80 | 28 | 108 |
| 2024 Junio | 92 | 31 | 123 |
| 2024 Mayo | 65 | 28 | 93 |
| 2024 Abril | 77 | 27 | 104 |
| 2024 Marzo | 101 | 22 | 123 |
| 2024 Febrero | 87 | 31 | 118 |
| 2024 Enero | 71 | 27 | 98 |
| 2023 Diciembre | 88 | 22 | 110 |
| 2023 Noviembre | 93 | 28 | 121 |
| 2023 Octubre | 67 | 19 | 86 |
| 2023 Septiembre | 80 | 30 | 110 |
| 2023 Agosto | 46 | 26 | 72 |
| 2023 Julio | 79 | 31 | 110 |
| 2023 Junio | 78 | 18 | 96 |
| 2023 Mayo | 70 | 20 | 90 |
| 2023 Abril | 75 | 27 | 102 |
| 2023 Marzo | 108 | 39 | 147 |
| 2023 Febrero | 78 | 22 | 100 |
| 2023 Enero | 69 | 32 | 101 |
| 2022 Diciembre | 66 | 31 | 97 |
| 2022 Noviembre | 56 | 30 | 86 |
| 2022 Octubre | 40 | 23 | 63 |
| 2022 Septiembre | 35 | 34 | 69 |
| 2022 Agosto | 49 | 35 | 84 |
| 2022 Julio | 27 | 35 | 62 |
| 2022 Junio | 60 | 25 | 85 |
| 2022 Mayo | 81 | 46 | 127 |
| 2022 Abril | 67 | 49 | 116 |
| 2022 Marzo | 64 | 60 | 124 |
| 2022 Febrero | 59 | 26 | 85 |
| 2022 Enero | 64 | 40 | 104 |
| 2021 Diciembre | 44 | 49 | 93 |
| 2021 Noviembre | 72 | 55 | 127 |
| 2021 Octubre | 117 | 62 | 179 |
| 2021 Septiembre | 60 | 49 | 109 |
| 2021 Agosto | 49 | 49 | 98 |
| 2021 Julio | 37 | 45 | 82 |
| 2021 Junio | 41 | 36 | 77 |
| 2021 Mayo | 52 | 54 | 106 |
| 2021 Abril | 110 | 91 | 201 |
| 2021 Marzo | 74 | 35 | 109 |
| 2021 Febrero | 66 | 62 | 128 |
| 2021 Enero | 45 | 53 | 98 |
| 2020 Diciembre | 43 | 41 | 84 |
| 2020 Noviembre | 47 | 44 | 91 |
| 2020 Octubre | 25 | 30 | 55 |
| 2020 Septiembre | 58 | 23 | 81 |
| 2020 Agosto | 31 | 35 | 66 |
| 2020 Julio | 32 | 24 | 56 |
| 2020 Junio | 45 | 35 | 80 |
| 2020 Mayo | 16 | 17 | 33 |
| 2020 Abril | 23 | 18 | 41 |
| 2020 Marzo | 25 | 13 | 38 |
| 2020 Febrero | 9 | 0 | 9 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 8 | 0 | 8 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 8 | 0 | 8 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 6 | 1 | 7 |
| 2019 Abril | 2 | 0 | 2 |
| 2019 Febrero | 4 | 0 | 4 |
| 2018 Diciembre | 2 | 0 | 2 |
| 2018 Noviembre | 5 | 0 | 5 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Abril | 2 | 0 | 2 |
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