This is a 42 year old right hand dominant female who recently presented complaining of the presence of a left palmar mass. Patient states the mass has been present for several months. She notes increase in size. In addition she notes tenderness with flexion of the metacarpophalangeal joint. Patient states the mass is also irritated by her rings. Patient will now undergo excision. Risk benefits and alternative procedure have been discussed with the patient.
Risks including but not limited to bleeding, infection, scarring, of poor wound healing, digital nerve injury, inadequate excision of a need for additional surgery have all been reviewed with the patient, who wished to precede. PROCEDURE The patient was taken to the operating room, placed supine on the operating table with the left arm extended on a arm board. The patient’s left hand and forearm were then prepped with Betadine and draped with standard surgical fashion. 1% lidocaine and 0. 25% Marcaine mixed 50/50 was then injected to provide a local field block.
The patient’s arm was then elevated. An Esmarch bandage was placed around the hand and Jennifer Summers 04/24/20 Page 2 forearm. The tourniquet was then inflated to 250mL of mercury. The Esmarch bandage was removed. A 2cm vertical incision was made overlying the mass. The incision was carried through the skin and subcutaneous tissue with a 15-blade scalpel. The ganglion cyst was then encountered.
The cyst was carefully grasped and dissected free from the surrounding tissue. The cyst was then dissected off the tendon sheath. Care was taken to excise the cyst in its entirety. The specimen was removed and passed off the table and sent to pathology for permanent sectioning.
The wound was then irrigated with normal saline. The skin was then reapproximated with interrupted horizontal mattress sutures with 4-0 Prolene. The tourniquet was then deflated for a total tourniquet time of 4 minutes. The wound was clean and dry. Xeroform, a dry sterile dressing was applied. Gauze, Kling, and ace bandage were then applied as a hand dressing. At this point the operation was terminated, the patient having tolerated procedure well. The patient was transferred to the ambulatory surgery unit in stable condition. _________________________ Sonya Pitt, Md SP:LS d: 04/24/20 t: 04/24/20.