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A Novel Use of Umbilical Perinatal Graft in Subungual Exostosis Resection

Juan Carlos Goez
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Roger Lee Kilfoil Jr
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Chen-An Wang
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Zachary Sax
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Farzana Arif
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Nail pathologies have a broad range of origin and may sometimes be complicated in presentation or clinical course, specifically when the pathology remains recalcitrant after treatment. In this case report we discuss a pathologic disorder that was initially misdiagnosed as a pyogenic granuloma surrounding an ingrown nail but was later found to be a benign neoplastic bone growth, Dupuytren exostosis, also known as a subungual exostosis. Operative treatment was deemed appropriate for the patient, and the exostosis was resected, leaving a soft-tissue void at the distal toe. The remaining void was filled with a perinatal graft, the use of which has been deemed effective anecdotally in both chronic and acute lower-extremity wounds but has not been widely discussed in the lower-extremity literature. This graft was placed to aid in wound healing over a potentially difficult wound bed. As amniotic, chorionic, and umbilical grafts become more prevalent in lower-extremity surgery, its antitumor effects should be further explored and published. This is the first case report, to our knowledge, of the successful use of a perinatal graft in the setting of a bone tumor, and it demonstrates that certain benign neoplasms can be treated with resection and placement of a perinatal graft while helping to prevent chronic wounds at surgical sites.

Department of Surgery, South Nassau Communities Hospital, Oceanside, NY.

Department of Pathology, South Nassau Communities Hospital, Oceanside, NY.

Corresponding author: Roger Lee Kilfoil, Jr, DPM, Department of Surgery, South Nassau Communities Hospital, 830A Atlantic Ave, Baldwin, NY, 11755. (E-mail: Rogerkilfoiljr@gmail.com)