{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T02:39:53Z","timestamp":1747190393031,"version":"3.40.5"},"reference-count":27,"publisher":"Wiley","license":[{"start":{"date-parts":[[2021,9,30]],"date-time":"2021-09-30T00:00:00Z","timestamp":1632960000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Case Reports in Orthopedics"],"published-print":{"date-parts":[[2021,9,30]]},"abstract":"<jats:p>Introduction. Amputation for subungual malignancy (SUM) was thought to be the gold standard in preventing recurrence and metastasis. The rationale behind this aggressive treatment was never based on scientific evidence. Even though multiple recent studies supported more conservative management by illustrating successful results of the digit salvage technique, especially for \u201cin situ\u201d SUM, this salvage approach is not well supported for the more aggressive type of the \u201cinvasive\u201d SUM; herein, we salvaged two cases of \u201cinvasive\u201d SUM. Case Presentation. We present two cases of invasive SUM without radiographic evidence of intraosseous involvement, where we avoided digit amputation for both invasive subungual squamous cell carcinoma of the thumb and invasive subungual melanoma of the ring finger. Both were salvaged by using a triple technique under awake local anesthesia which included (I) radical excision of the nail bed unit including both eponychium and periosteum, (II) dorsal cortical bone shaving using a high-speed burr for the distal phalanx, and (III) flap coverage. Brunelli flap was used for the thumb in the first case, and V-Y plasty combined with proximal nail fold advancement flap was used for the ring finger in the second case. There was no evidence of local or distant recurrence, with a good functional outcome after 2.5 years in the first case and 2 years in the second. Conclusion. Ensuring complete resection with negative margins while preserving the functionality of the affected digit is considered to be the optimal challenge in treating \u201cinvasive\u201d subungual malignancies. These two case reports contribute by reporting a successful digit salvage. The safety of this procedure could be confirmed by larger series and longer follow-up periods.<\/jats:p>","DOI":"10.1155\/2021\/4648627","type":"journal-article","created":{"date-parts":[[2021,10,1]],"date-time":"2021-10-01T05:15:14Z","timestamp":1633065314000},"page":"1-7","source":"Crossref","is-referenced-by-count":2,"title":["Salvaging the Digit in Invasive Subungual Malignancies Using a Triple Technique under Awake Local Anesthesia"],"prefix":"10.1155","volume":"2021","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8354-3323","authenticated-orcid":true,"given":"Samer Abdel","family":"Al","sequence":"first","affiliation":[{"name":"Department of Orthopedic, Hand and Microsurgery, King Hussein Cancer Center, Amman, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamad K.","family":"Abou Chaar","sequence":"additional","affiliation":[{"name":"Department of Surgery, King Hussein Cancer Center, Amman, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ala\u2019a Aldeen","family":"Alkhatib","sequence":"additional","affiliation":[{"name":"Department of Surgery, King Hussein Cancer Center, Amman, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhamad","family":"Al-Qawasmi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic, Hand and Microsurgery, King Hussein Cancer Center, Amman, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad","family":"Barham","sequence":"additional","affiliation":[{"name":"Department of Surgery, King Hussein Cancer Center, Amman, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sameer","family":"Yaser","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, King Hussein Cancer Center, Amman, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samer","family":"Salah","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, King Hussein Cancer Center, Amman, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abed Al Raheem","family":"Suleiman","sequence":"additional","affiliation":[{"name":"Department of Research, King Hussein Cancer Center, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wafa","family":"Asha","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, King Hussein Cancer Center, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-019-6248-2"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.4103\/0974-2077.91247"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1148\/rg.306105514"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2018.01.010"},{"issue":"3","key":"5","first-page":"269","article-title":"The treatment of nail apparatus melanoma with Mohs micrographic surgery","volume":"27","author":"D. 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