Single stage reconstruction of the right thumbnail with Novosorb® Biodegradable Temporizing Matrix (BTM) following...

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.