DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Recurrent right volar carpal ganglion.
POSTOPERATIVE DIAGNOSIS: Recurrent right volar carpal ganglion.
PROCEDURE PERFORMED: Excision of recurrent right volar carpal ganglion.
SURGEON: John Doe, MD
ANESTHESIA: Preoperative regional block with sedation.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
SPECIMENS: Right volar carpal ganglion for permanent pathology.
OPERATIVE FINDINGS: Moderate amount of scar tissue was identified around the radial artery, and a volar carpal ganglion was found to be emanating through the interval between the radial artery and the flexor carpi radialis tendon. The ganglion was traced down following its stalk to the volar radiocarpal joint. A mild amount of synovitis was appreciated from the joint. The volar radiocarpal ligaments were intact with a weakened spot where the stalk of the ganglion was coming from. A second more distal mass had been noted preoperatively, and this was found to be thickened fibrous tissue overlying the flexor carpi radialis tendon, which was also sharply excised. It was not a second ganglion. There did not appear to be any pathology emanating from the STT joint.
DESCRIPTION OF OPERATION: After obtaining informed consent, identifying correct patient and correct operative site, the patient had placement of adequate right upper extremity regional anesthetic. She was then taken to the operating suite where she was placed supine on the operating table, and all pressure points were well padded. The right upper extremity was then prepped and draped in the usual sterile fashion on a hand table. She received preoperative IV antibiotics. The hand was exsanguinated with an Esmarch bandage, and a well-padded brachial tourniquet was inflated to appropriate arm pressure.
The previous hockey stick-shaped incision was reutilized and extended proximally into virgin tissue to allow for identification of the radial artery and tracing it distally. This was identified and protected. It was traced distally with the above findings noted. One of the venae comitantes was noted to be intimately associated with the ganglion, and this was cauterized with bipolar electrocautery to allow further mobilization of the radial artery. The vessel was immobilized, and the ganglion was traced down along its stalk through the volar radiocarpal ligaments to the radiocarpal articulation. It was transected at its origin and the base was debrided with a rongeur. Then the edges were thoroughly cauterized with bipolar. A moderate amount of synovitis was also debrided with a rongeur. A moderate amount of synovial fluid emanated from the wrist joint. However, this appeared benign in nature. The second more distal nodule was found to be fibrous tissue overlying the flexor carpi radialis tendon, which was sharply excised. There did not appear to be any pathology emanating from the STT joint itself.
The bed was then thoroughly irrigated with normal saline and closed in layers with inverted 5-0 plain suture and 4-0 Prolene in horizontal mattress sutures, reapproximating the skin edges. It was dressed with Xeroform and a lightly compressive, bulky, short arm dressing with a volar plaster splint. The tourniquet was deflated with excellent circulatory return to her hand. The patient was taken to the recovery room in stable condition having tolerated the procedure without difficulty.
