25135 Excision or curettage of bone cyst or benign tumor of carpal bones; with autograft (includes obtaining graft)

Name of the Procedure:

Excision or Curettage of Bone Cyst or Benign Tumor of Carpal Bones with Autograft

Summary

This procedure involves the surgical removal (excision) or scraping (curettage) of a non-cancerous cyst or tumor located in the carpal bones of the wrist. An autograft, which is a bone graft taken from another part of the patient's own body, is used to fill the void and promote healing.

Purpose

This procedure addresses the presence of cysts or benign tumors in the carpal bones that may cause pain, limit movement, or have the potential to weaken the bone and cause fractures. The goal is to remove the abnormal growth, restore structural integrity, and alleviate symptoms.

Indications

• Chronic pain in the wrist
• Swelling or noticeable lump in the wrist area
• Restriction in wrist movement
• Risk of bone fracture due to the cyst or tumor
• Failure of conservative treatments like medication and physiotherapy

Preparation

• Patients may need to fast for a specified period before the procedure.
• Medication adjustments might be required, especially if the patient is on blood thinners.
• Preoperative imaging studies like X-rays or MRI to assess the cyst or tumor.
• Routine blood tests and possible ECG to ensure patient is fit for surgery.

Procedure Description

1. Anesthesia is administered to make the procedure painless, usually local or regional anesthesia, sometimes combined with sedation.
2. A surgical incision is made over the affected carpal bone.
3. The cyst or tumor is carefully excised or curetted from the bone.
4. A bone graft is harvested from another site, usually the iliac crest (part of the pelvic bone).
5. The bone graft is placed into the void left by the cyst or tumor to promote healing and stabilize the bone.
6. The incision is closed with sutures, and a sterile dressing is applied.

Duration

Typically, the procedure takes about 1 to 2 hours, depending on the complexity and size of the cyst or tumor.

Setting

The procedure is usually performed in a hospital operating room or a surgical center.

Personnel

• Orthopedic or hand surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses or assistants

Risks and Complications

• Infection at the surgery site
• Bleeding or hematoma
• Graft failure or non-union
• Nerve damage causing numbness or tingling
• Recurrent cyst or tumor
• Adverse reactions to anesthesia

Benefits

• Relief from chronic pain and discomfort
• Restoration of normal wrist function and mobility
• Strengthening of the carpal bones and prevention of fractures
• High success rates with long-term improvements

Recovery

• Immobilization of the wrist with a splint or cast for several weeks.
• Pain management with prescribed medications.
• Instructions on wound care and signs of infection to watch for.
• Follow-up appointments for monitoring healing and possible physical therapy to restore movement.
• Full recovery can span from a few weeks to several months, depending on individual healing rates and adherence to postoperative care.

Alternatives

• Observation and regular monitoring if the cyst or tumor is asymptomatic.
• Non-surgical treatments such as medication for pain and inflammation.
• Aspiration of the cyst, though this may not provide a permanent solution.

Patient Experience

• Patients can expect to experience some pain and swelling after the procedure, which will be managed with medications.
• Discomfort at the graft site, especially if the iliac crest is used, which typically resolves within a few days.
• Most patients return to normal activities gradually, with personalized guidance on wrist exercises.
• Regular follow-up visits ensure proper healing and rehabilitation.