Critical length salvage technique for thumb: Nail and nail bed removal due to squamous cell carcinoma and verruca vulgaris: A case report

This article presents a previously unpublished technique successfully utilized to treat two neoplastic lesions of the thumb nail bed, while aiming to retain motor and sensory function by maximizing length of the digit. We present a unique case of concomitant verruca vulgaris and squamous cell carcinoma in the nail bed and surrounding areas of a 75-year-old Caucasian male's thumb. There is not a defined treatment algorithm for this presentation, however, due to its malignant nature and possibility for metastasis, carcinoma must be resected with good margins. Treatment options include amputation at the interphalangeal joint, or resection with adequate margins that would involve the distal phalanx. In this case, we removed the nail bed and used the remainder of the phalanx to create a shortened distal portion of the 1st digit in an attempt to prevent functional loss. Through the utilization of this technique in patients who present with similar findings, the application of this procedure may prove beneficial in returning the patient to normal activity. While Dermatologic and Orthopaedic hand specialties would benefit the most from this technique, there is precedent that this technique may be applied in altered cases.