Os styloideum is an accessory wrist bone at the base of the second and third metacarpals. Similar to metacarpal bossing, chronic pain secondary to the development of osteoarthritis and tendon irritation is common. Conservative management consists of splinting and steroid injections, with surgical resection being the definitive treatment. 2-Octyl cyanoacrylate adhesive glue is commonly used to close these and other types of wounds.
We report the case of a 29-year-old man who developed severe dermatitis following surgical removal of a right dorsal hand mass at the base of the third metacarpal, which had been slowly enlarging and causing pain for 18 months.
After unsuccessful conservative management, the mass was resected and the incision was closed with buried monofilament suture and 2-octyl cyanoacrylate skin glue. Upon splint removal due to pain, 6 days postoperatively, severe contact dermatitis resulting in scattered partial- and full-thickness skin necrosis was observed. Local wound care, systemic corticosteroids, and a secondary surgical closure were required for resolution of the skin breakdown.
This case demonstrates 2 uncommon occurrences: a rare hand mass and severe contact dermatitis to 2-octyl cyanoacrylate with resultant tissue necrosis. Mass resection is commonly reserved for symptomatic os styloideum. Caution should be used when applying 2-octyl cyanoacrylate under a splint. Removal of glue and steroids provides effective treatment for severe contact dermatitis, but full-thickness injuries may require debridement and secondary closure.