From the Department of Plastic and Reconstructive Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Osaka, Japan.
Ann Plast Surg. 2021 May 1;86(5):532-535. doi: 10.1097/SAP.0000000000002619.
Subungual exostosis is a benign tumor that occurs under the nail plate of the distal phalanx and causes nail deformity and pain. There are many reports of recurrence and postoperative nail deformity, and the surgical approach needs to be reassessed. Two typical surgical approaches are from the nail fold and the nail bed. Here, we compare 2 surgical approaches for subungual exostosis that were performed in our department. Twenty-three cases of subungual exostosis were treated between 2010 and 2019; 12 cases were treated by the nail fold approach and 11 by the microscopic nail bed approach. The nail fold approach resulted in not only scarring but also nail deformities, such as onychodystrophy. There were 2 (18.2%) cases of recurrence. In the microscopic nail bed approach, there was no case of recurrence. It was possible to preserve the thinned nail bed by dissecting under a microscope, and the thinned nail bed did not become necrotic in any cases. To solve postoperative nail deformity and a high recurrence rate, sufficient resection and meticulous surgical procedure on the nail bed and nail matrix are essential. The microscopic nail bed approach satisfied both of these criteria and was considered to be a useful method for subungual exostosis.
甲下外生骨疣是一种良性肿瘤，发生于远节指骨的甲下，引起指甲畸形和疼痛。有许多关于复发和术后指甲畸形的报道，需要重新评估手术方法。两种典型的手术方法是从甲皱襞和甲床。在这里，我们比较了我们科室治疗的两种甲下外生骨疣的手术方法。2010 年至 2019 年间治疗了 23 例甲下外生骨疣；12 例采用甲皱襞入路，11 例采用显微镜下甲床入路。甲皱襞入路不仅导致瘢痕形成，而且导致指甲畸形，如甲营养不良。有 2 例（18.2%）复发。在显微镜下甲床入路中，没有复发的病例。通过在显微镜下解剖，可以保留变薄的甲床，而且在任何情况下，变薄的甲床都不会坏死。为了解决术后指甲畸形和高复发率的问题，需要对甲床和甲母质进行充分的切除和精细的手术操作。显微镜下甲床入路符合这两个标准，被认为是治疗甲下外生骨疣的一种有用方法。
