Indications:
This procedure is indicated for a number of conditions around the wrist joint, hand and fingers. Common indications are for ganglion (fluid sac) excision around the wrist, mucous cyst (fluid sac of fingers) excision, lipoma (fat tumour) excision, benign (harmless) nerve (neuroma) or tendon sheath (giant cell) tumour excision, benign (harmless) bone tumour (enchondroma) curettage. Rarely malignant (rapidly spreading cancer type conditions) may need wide local or radical excision.
What to expect before surgery
If you are to undergo this procedure with Dr Bala, you will usually consult a member from the anaesthetic team a few hours prior to the surgery. You may be required to bring some of your more recent investigations including a chest x-ray, ECG and routine blood tests and your old scans. If required the nurse or physician may order more tests if required. The procedure is usually performed under general anaesthesia. The anaesthetist may further discuss these with you. The procedure and anaesthesia are usually for an hour or 2. Most wrist hand and finger tumour surgeries are day surgery procedures meaning you will usually go home the same day should you be well.
The nurse will instruct you on the time you should start fasting prior to the surgery start time, the reporting time into the hospital and the possible discharge time. It may be possible to shower the night before surgery keeping the wrist or hand dry and remove jewellery at home.
On the day of surgery
It is good to report a couple of hours prior to the scheduled operation time to enable time for you to change into the hospital gown and be reviewed by the anaesthetist and the surgeon. The only prick you might feel is that of the IV line prior to anaesthesia. A ‘timeout’ is done to ensure that the entire team is satisfied with the side, procedure and equipment. The anaesthetist will give you some sleep medicines 1st to make you comfortable and you may request for your choice of music as drowse off to sleep. You will usually be given automatic calf compressors which massage the calf muscles during the duration of the surgery to prevent blood clots from forming. You will also be given an electrical warming blanket to ensure your body remains warm during the duration of the surgery. An IV antibiotic (usually cefazolin) is administered prior to surgical incision.
Surgery
Anaesthesia is usually given on the operating table. An ordinary table with a radiolucent hand table attachment is used. The procedure is done with you lying on your back. Once you are comfortably positioned on the operating table with adequate cushioning, a tourniquet is applied which is like a blood pressure cuff to keep blood out of the field of surgery to help improve visibility of important structures. Then the operating side is cleaned and draped. The upper limb is drained of blood using elevation and the tourniquet is inflated to keep blood out and the procedure is begun. Once the tumour has been fully removed and the field cleared of all tumour tissue, Dr Bala closes the wounds with absorbable or non-absorbable sutures. The operated area is cleaned and a compressive waterproof dressing is applied to soak up the ooze. Rarely a partial plaster maybe applied to the wrist or hand or splints if bone has been removed. Sometimes the fingers are splinted or taped to the neighbouring fingers (buddy taping) to protect them for 2 weeks. A collar and cuff sling is usually provided to support the wrist and hand after surgery. The tumour samples are sometimes sent for histopathological examination. The drapes are removed and you will be shifted back to the trolley from the operating table after the procedure is complete.
For more details of specific procedures performed you may visit the following pages of this website
Ganglion https://pradeepbala.com/conditions-treated/ganglion/
Hand and finger tumours https://pradeepbala.com/conditions-treated/tumours-of-the-hand/
After surgery
You are usually kept in the observation bay in the operating theatre for a couple of hours and may either be shifted to the ward or discharged directly from the theatre. Once you are fully awake, have had a few sips of water without throwing up, can move all of your fingers comfortably without pain you may be discharged.
Dr Bala may either phone your closest relative or see you before you are discharged.
Follow up
You will be allowed to allowed to shower a couple of days after the surgery ensuring that the plaster remains dry if at all. If there is no plaster splint or tape the outer dressing maybe removed at day 3 to 5 and the wound washed with soap and water. The physiotherapist will instruct you to as to what movements you can and cannot do after surgery. Dr Bala sees his post op patients at around 2 weeks after surgery. There maybe a few sutures to remove if at all. You may require some intense sessions of hand therapy after surgery to optimize the function of your wrist and fingers. Dr Bala will review x-rays at 2, 6, 2 weeks and subsequently if required. The biopsy report is usually followed up at 2 weeks and any additional therapy if required initiated.