Sakamoto Kento, Ishii Naohiro, Itabashi Yuki, Matsuzaki Kyoichi, Kishi Kazuo
Department of Plastic and Reconstructive Surgery, International University of Health and Welfare Hospital, Tochigi, Japan.
Department of Plastic and Reconstructive Surgery, School of Medicine, International University of Health and Welfare, Chiba, Japan.
AME Case Rep. 2024 Jun 28;8:81. doi: 10.21037/acr-24-26. eCollection 2024.
Subungual exostosis is a type of heterotopic ossification, which often has unclear margins. Therefore, marginal resection may cause recurrence and wide resection is sometimes required to achieve a complete cure. However, wide resection may cause postoperative nail deformity and revision of this deformity is generally difficult. The primary treatment of subungual exostosis is surgical treatment, and there have been no comprehensive reports on the efficacy of adjunctive treatments. Although postoperative electron beam irradiation has been successfully used after heterotopic ossification excision to prevent recurrence, there are no reports on the use of this procedure following subungual exostosis resection.
Herein, we report a case of refractory subungual exostosis that developed as a result of chronic irritation and inflammation caused by an ingrown nail and recurred after initial resection. We performed marginal resection of the lesion to preserve the nail matrix and nail bed as possible, a two-stage skin grafting procedure, and electron-beam irradiation to prevent recurrence.
Excellent results were achieved both in terms of complete cure and cosmetic appearance, suggesting that electron-beam irradiation following refractory subungual exostosis excision may help prevent its recurrence. We expect a further study including many cases of subungual exostosis treated with postoperative electron-beam irradiation to be conducted.
甲下外生骨疣是一种异位骨化类型，其边界通常不清晰。因此，边缘切除可能导致复发，有时需要广泛切除以实现完全治愈。然而，广泛切除可能导致术后指甲畸形，而这种畸形的矫正通常很困难。甲下外生骨疣的主要治疗方法是手术治疗，目前尚无关于辅助治疗疗效的综合报道。尽管异位骨化切除术后成功应用术后电子束照射预防复发，但甲下外生骨疣切除术后应用该方法尚无报道。
在此，我们报告一例难治性甲下外生骨疣病例，该病例由嵌甲引起的慢性刺激和炎症发展而来，初次切除后复发。我们对病变进行了边缘切除，尽可能保留甲母质和甲床，采用两阶段植皮手术，并进行电子束照射以预防复发。
在完全治愈和外观方面均取得了优异的效果，表明难治性甲下外生骨疣切除术后进行电子束照射可能有助于预防其复发。我们期待开展一项纳入更多术后接受电子束照射治疗的甲下外生骨疣病例的进一步研究。
