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

Background: 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. Case presentation: 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. Outcome: 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. Conclusion: 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.