A novel management strategy for subungual exostosis

Abstract

Subungual exostosis is a relatively uncommon benign bone tumour that mostly affects the toes of young people and can be a source of significant impact on health-related quality of life. Treatment consists of marginal excision and meticulous wound closure. We presented a case of subungual exostosis in the hallux of a young Caucasian girl. Once diagnosed, the lesion was completely excised leaving a sizable defect in the nail bed and skin folds. A pedicled vacuum assisted closure (VAC) device was used postoperatively in an attempt to minimise the tissue deficit. At 1-year follow-up, the nail had regrown and tissue reformed producing an optimal functional and cosmetic result with no recurrence. Postoperative wound complications in the setting of subungual exostosis are significant and a great variability exists in their appropriate management. We presented the novel use of the VAC device in the successful management of subungual exostosis.

Figure 1

A 13-year-old girl presenting with pain and an enlarging mass in her right hallux. Clinical pictures (A and B) and radiographs (C and D).

Figure 2

Intraoperative image of the right great toe after exostosis resection (A and B). The excised osteocartilaginous growth sent for pathological analysis (C). Histological specimen showing dermis with normal trabecular bone and fibrocartilaginous tissue overgrowth.

Figure 3

Pedicled vacuum-assisted closure (VAC) negative pressure dressing postoperative therapy for 12 days.

Figure 4

One-year follow-up with clinical picture (A) and radiograph (B).