26113 Excision, tumor, soft tissue, or vascular malformation, of hand or finger, subfascial (eg, intramuscular); 1.5 cm or greater

Name of the Procedure:

Excision of Tumor or Vascular Malformation of the Hand or Finger: Subfascial (e.g., Intramuscular); 1.5 cm or Greater

Summary

This procedure involves surgically removing a tumor or vascular malformation located beneath the fascial layer in the hand or finger. The excision is for growths that are 1.5 cm or larger and often requires accessing deeper soft tissues, including the muscles.

Purpose

The procedure is intended to treat abnormal growths such as tumors or vascular malformations that may cause pain, interfere with hand function, or have the potential to become malignant. The goal is to remove the problematic tissue while preserving as much function as possible.

Indications

• Presence of a tumor or vascular malformation in the hand or finger measuring 1.5 cm or greater.
• Symptoms such as pain, swelling, or reduced hand/finger function.
• MRI, CT, or ultrasound imaging indicating the necessity for surgical removal.
• Biopsy results suggesting the need for excision.

Preparation

• Fasting for at least 8 hours prior to the procedure.
• Discontinuation of certain medications, as directed by the physician.
• Pre-surgical evaluation including blood tests, imaging studies, and possibly an ECG.
• Signed informed consent after discussing risks and benefits.

Procedure Description

1. The patient is given either local anesthesia with sedation or general anesthesia, depending on the size and location of the tumor and patient preference.
2. An incision is made over the affected area of the hand or finger.
3. Soft tissues are carefully dissected to access the tumor or malformation beneath the fascias and within the muscle tissue.
4. The tumor or malformation is excised completely, taking care to avoid damage to surrounding nerves and vessels.
5. The wound is closed with sutures, and a sterile dressing is applied.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity and size of the growth.

Setting

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

Personnel

• Orthopedic or general surgeon specializing in hand procedures.
• Anesthesiologist or nurse anesthetist.
• Surgical nurses and support staff.

Risks and Complications

• Infection
• Bleeding and hematoma formation
• Scarring
• Nerve damage leading to loss of sensation or movement
• Recurrence of the tumor or malformation
• Reaction to anesthesia

Benefits

• Relief from pain and discomfort.
• Improved hand or finger function.
• Reduced risk of malignancy if the tumor is cancerous.
• Enhanced quality of life.

Recovery

• Keep the hand elevated to reduce swelling.
• Pain management with prescribed medications.
• Limited use of the hand for several weeks; possibly wearing a splint.
• Follow-up appointments to check healing and remove sutures.
• Physical therapy might be recommended to regain strength and flexibility.

Alternatives

• Observation and regular monitoring if the tumor is benign and asymptomatic.
• Non-surgical treatments such as radiation or embolization for certain vascular malformations.
• Lesser invasive procedures depending on tumor location and size.
• Pros and cons: Non-surgical options may avoid operative risks but might not be as definitive as excision.

Patient Experience

• During the procedure, the patient will either be sedated or asleep.
• Post-procedure, patients may experience pain and swelling, managed with medications and ice.
• Most patients report improvements in symptoms once healed, although some may experience extended discomfort or require further rehabilitation.