Single stage reconstruction of the right thumbnail with Novosorb® Biodegradable Temporizing Matrix (BTM) following massive glomus tumor resection

TL;DR

A new single-stage surgical method using a biodegradable matrix successfully reconstructed a thumb after a large tumor removal, avoiding complex procedures and achieving good recovery.

Contribution

A novel single-stage reconstruction technique using Biodegradable Temporizing Matrix (BTM) for thumb reconstruction after glomus tumor resection is introduced.

Findings

The BTM fully integrated within 4 weeks, allowing wound healing without skin grafts.

At 6 months, the patient had excellent functional outcomes with full range of motion and no pain.

The single-stage approach proved effective as an alternative to multi-stage reconstruction.

Abstract

Glomus tumors are rare, benign vascular neoplasms arising from glomus bodies, often presenting with localized pain and functional limitation. The tumors commonly arise in the sub-ungual region of the distal phalanx and can be locally destructive, posing a unique reconstructive challenge.

We report the case of a 47-year-old male, presenting with a glomus tumor of the distal phalanx of the right thumb, involving more than 70 % of the nailbed resulting in severe pain and functional impairment. Imaging confirmed significant bone erosion of the distal phalanx. Surgical excision with germinal matrix ablation was performed, achieving complete resection. A novel single-stage reconstruction of the right thumb with exposed distal phalanx and nailbed loss was undertaken using a dermal fat graft from the right forearm and Biodegradable Temporizing Matrix (BTM). This approach precluded a complex multi-stage reconstruction and enabled immediate defect coverage and restoration of structural integrity.

At 4 weeks review, the BTM had fully integrated and was delaminated to reveal a vascularized wound bed. The wound was left to heal by secondary intention and no skin graft was performed. At 6 months post-operatively, functional outcomes were excellent with restoration of full active range of motion without pain or hypersensitivity.

This case highlights the efficacy of single-stage BTM reconstruction following glomus tumor excision involving the distal phalanx and nail bed. The approach offers a promising alternative to conventional multi-stage reconstruction, ensuring optimal recovery and function. Further studies are needed to validate the efficacy of BTM in hand reconstruction.

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