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Excision of Volar Ganglion Cyst Operative Example


Volar ganglion cyst, left wrist.

Volar ganglion cyst, left wrist.

Excision of volar ganglion cyst, left wrist.

SURGEON:  John Doe, MD

ANESTHESIA:  Axillary block.

INDICATIONS FOR OPERATION:  The patient is a (XX)-year-old gentleman with persistent cystic swelling in the left volar wrist.  He now presents for surgical excision.  Preoperatively, risks, benefits, complications, postoperative course, and alternatives to surgery were discussed, and informed consent was obtained for the procedure.





DESCRIPTION OF OPERATION:  The patient was identified in the holding area.  Appropriate surgical limb and site were confirmed and marked.  Axillary block anesthetic was administered.  The patient was brought to the operating room and placed in the supine position on the operating room table.  The left upper limb was prepped and draped in the routine fashion.  The upper limb was exsanguinated with an Esmarch bandage and the previously placed and well-padded pneumatic tourniquet inflated to 280 mmHg.  A 3.5 loupe magnification was used throughout.

Longitudinal incision was made overlying the cyst, paralleling the course of the radial artery.  The incision was deepened through the skin and subcutaneous tissue.  The cyst was immediately encountered.  This was a bilobular cyst that was septated due to vena comitantes of the radial artery, that were septating the cyst, as they were embedded in the wall of the cyst.  Dissection proceeded around the cyst wall.  It was necessary to ligate vena comitantes branches and small feeding branches and tributaries of the radial artery.  These were ligated with hemoclips and were cauterized.  The cyst was dissected first proximally, where it was carefully dissected off of the radial artery.  It appeared to have a root in the fascia of the flexor carpi radialis tendon.  This was excised along with a portion of the sheath.  The cyst was also tracked distally, where it was entering deep to the thenar musculature.

Dissection proceeded down to where it appeared to be arising out of the capsule of the scaphotrapezial joint.  This area was excised with a portion of capsule.  The cyst was felt to be consistent with benign synovial cyst and it was not sent for pathology.  The radial artery had been preserved.  Vena comitantes branches had, for the most part, been ligated.  The wound was irrigated with saline.  The tourniquet was deflated.  There was good hemostasis and good pulse through the radial artery.  There was good return of perfusion to the hand.

The wound was copiously irrigated with saline.  Hemostasis was again confirmed.  TLS drain was placed in the wound and brought out through a separate stab incision proximally.  The skin edges were reapproximated with interrupted 5-0 nylon.  The wound was dressed with antibiotic ointment and Adaptic, and bulky dressing reinforced with a volar fiberglass splint.

The patient tolerated the procedure well, was awakened in the operating room, and transported to the recovery room in stable condition.