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PREOPERATIVE DIAGNOSIS

1. Left palm mass.

POSTOPERATIVE DIAGNOSIS

1. Left ring finger tendon, she’s ganglion.

PROCEDURES

1. Incision of left ring finger ganglion cyst.

ANESTHESIA

Local EDL 2cc.

TOURNIQUET TIME

Four minutes.

COMPLICATIONS

None.

INDICATIONS

This is a 42-year-old radiant dominate female who recently presented complaining of the persistence of the left palm mass. Patient states the mass has been present for several months. She notes an increase in size. In addition, she notes tenderness with flexion of the MCP joints. Patient states the mass is also irritated by her rings. Patient will now undergo an incision. Risk benefits, and alternative procedures have been discussed with the patient. Risk included unlimited bleeding, infection, scaring, poor wound healing, digital nerve injury, inadequate incision, and the need for additional surgery. Risks involved were reviewed with the patient, and wished to proceed.

PROCEDURE

Patient was taken to the operating room, placed upon the operating table with the left arm extended on an arm board. The patients’ left hand and forearm were prepped with Betadine and draped in an surgical fashion. 1% lidocaine and quarter percent Marcaine mixed 50-50 was injected to provide a local field block. The patients’ forearm was elevated, an esmark bandage was placed around the hand and forearm. The tourniquet was then inflated to 250mm of mercury. The esmark bandage was removed. A 2cm vertical incision was made over-lining the mass. The incision was carried through the skin in

subcutaneous tissue with 50-laid scapula. The ganglion and cyst were encountered. The cyst was carefully grafted and dissected free from the surrounding tissue. The cyst was then dissected off the tendon sheet. 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 masseur sutures of 4-0 proline. The tourniquet then deflated for a total of tourniquet time of four minutes. The wound was clean and dry. 0-4 dry, sterile dressing were applied. Cloth clings, and ace bandages were then applied as a hand dressing. At this point, the operation was terminated, the patient having tolerated the procedure well. The patient was transferred to ambulatory surgery in a stable condition.