21933 Excision, tumor, soft tissue of back or flank, subfascial (eg, intramuscular); 5 cm or greater

Name of the Procedure:

Excision of Soft Tissue Tumor from Back or Flank (Subfascial, 5 cm or Greater) Common names: Soft tissue tumor removal, Intramuscular tumor excision

Summary

This procedure involves surgically removing a tumor from the soft tissues located beneath the muscle fascia in the back or flank area. The tumor must be 5 centimeters or larger for this specific procedure.

Purpose

Condition Addressed:

• Soft tissue tumors located in the back or flank that are intramuscular and subfascial.

  Goals/Outcomes:

• Complete removal of the tumor, ensuring a clean margin to prevent recurrence.
• Relief of symptoms caused by the tumor, such as pain or discomfort.
• Diagnosis confirmation through histological examination of the removed tissue.

Indications

Symptoms/Conditions:

• Presence of a palpable mass in the back or flank.
• Pain or discomfort in the affected area.
• Suspicion of malignancy based on imaging or biopsy.

Patient Criteria:

• Tumor size of 5 cm or greater.
• Tumor located beneath the muscle fascia (not superficial).
• Overall patient health allows for surgical intervention.

Preparation

Pre-procedure Instructions:

• Fasting for at least 8 hours before surgery.
• Discontinuation or adjustment of certain medications (e.g., blood thinners) as advised by the physician.
• Pre-operative diagnostic tests such as MRI or CT scans to assess the tumor's size and location.

Diagnostic Tests/Assessments:

• Imaging studies (MRI, CT scan).
• Potential biopsy to determine the nature of the tumor.

Procedure Description

Steps:

1. Administration of general anesthesia to ensure the patient is asleep and pain-free.
2. Surgical incision over the tumor site, tailored to the size and location of the tumor.
3. Careful dissection through the layers of skin and muscle to reach the subfascial tissue.
4. Identification and excision of the tumor, ensuring clear margins to minimize recurrence risk.
5. Closure of the surgical site with sutures or staples.
6. Application of a sterile dressing.

Tools/Equipment:

• Scalpel, forceps, retractors, electrocautery device.

Anesthesia:

• General anesthesia.

Duration

Typically takes between 1 to 3 hours, depending on the complexity and size of the tumor.

Setting

Performed in a hospital's operating room or a surgical center.

Personnel

• Surgeon (lead)
• Surgical nurses
• Anesthesiologist
• Surgical technicians

Risks and Complications

Common Risks:

• Infection at the surgical site.
• Bleeding.

Rare Risks:

• Damage to surrounding tissues or structures.
• Adverse reaction to anesthesia.
• Post-operative complications such as blood clots.

Management:

• Antibiotics for infection.
• Monitoring and managing bleeding.
• Post-operative observation for early detection and management of complications.

Benefits

• Complete removal of the tumor.
• Symptom relief.
• Histological analysis for accurate diagnosis.
• Low recurrence rate if clear margins are achieved.

Timeframe for Benefits:

• Symptom relief is often immediate.
• Diagnostic results available within a week.

Recovery

Post-Procedure Care:

• Pain management with prescribed medications.
• Wound care instructions.
• Activity restrictions to avoid strain on the surgical site.
• Follow-up appointments to monitor healing and check for any complications.

Expected Recovery Time:

• Full recovery typically takes 4 to 6 weeks.
• Gradual return to normal activities as advised by the physician.

Alternatives

Other Treatment Options:

• Observation and regular monitoring if the tumor is not causing symptoms or is benign.
• Radiotherapy or chemotherapy if the tumor is malignant but not surgically accessible.

Pros/Cons Compared to Excision:

• Observation avoids surgery but has the risk of tumor growth.
• Radiotherapy/chemotherapy can be effective but may have significant side effects and may not fully eliminate the tumor.

Patient Experience

During Procedure:

• No awareness or pain due to general anesthesia.

After Procedure:

• Post-operative pain managed with medications.
• Sensation of discomfort or tightness around the surgical site.
• Restrictions on physical activity to ensure proper healing.
• Regular follow-up for suture removal and monitoring.

Pain Management:

• Pain relief through oral or intravenous medications.
• Gradual improvement in pain and discomfort over a few days.