Modified trapdoor procedure versus complete nail removal for subungual glomus tumor excision at minimum 2 years follow-up

Abstract

Objectives Various surgical approaches were described for excision of the subungual glomus tumors of the nail bed, including transungual, periungual, and nail-plate-preserving or nail plate non-preserving approaches. This study aims to assess the clinical outcomes, recurrence rate, and postoperative complications of our modified trapdoor technique, compared with complete nail removal approach. Patients and methods A retrospective study was conducted on 42 patients with subungual glomus tumor of the nail bed of the hand with a minimum follow-up period of 24 months. Twenty-two patients underwent modified trapdoor excision of the tumor. Twenty patients underwent excision of the tumor through complete nail-plate removal. Outcome measures included the 100-mm visual analog scale, cold sensitivity, nail discoloration, nail regrowth rate, infection, and local recurrence. Results A significant reduction in pain and cold intolerance was observed postoperatively for all patients. The mean postoperative visual analog scale was similar in both groups. Two patients with postoperative split nail deformity were noted in the nail removal group. Other two patients with severe nail deformation due to recurrence were observed, one in each group, in addition to other two patients with nail plate deformity due to infection, one in each group. Three patients with recurrence were reported in the nail removal group, and two patients in the trapdoor group. Conclusions Both techniques are safe and effective. The modified trapdoor procedure is better reserved for patients with small tumors, while complete nail removal is indicated for those with larger and aggressive tumors, especially in the presence of preoperative nail deformity. Level of evidence Therapeutic level III.