Name of the Procedure:

Excision of bone cyst or benign tumor, wing of ilium, symphysis pubis, or greater trochanter of femur; deep (subfascial), includes autograft, when performed.

Summary

This surgical procedure involves the removal of a bone cyst or benign tumor from specific areas of the pelvis or femur. It is a deep surgery that goes below the fascia (a band or sheet of connective tissue) and may include the use of an autograft, which is a bone graft taken from another part of the patient’s body.

Purpose

This procedure is performed to remove benign tumors or cysts in the bone to prevent complications such as pain, fractures, or impaired movement. The goal is to eliminate the abnormal growth while preserving as much of the healthy bone and surrounding structures as possible.

Indications

• Persistent pain localized to the wing of ilium, symphysis pubis, or greater trochanter.
• Bone cysts identified through imaging that are causing symptoms or at risk of causing bone fractures.
• Benign tumors that, although non-cancerous, are growing or causing discomfort.
• Failure of conservative treatments like medication or physical therapy to alleviate symptoms.

Preparation

• Patients may be required to fast for several hours before the surgery.
• Preoperative assessments might include blood tests, imaging studies like X-rays or MRI, and a physical examination.
• Adjustments to medications, especially blood thinners and anti-inflammatory drugs, might be necessary.
• Discussion about the use of autografts and any potential donor sites will be conducted.

Procedure Description

1. The patient is administered general anesthesia.
2. An incision is made over the affected area.
3. The surgeon carefully dissects down to the bone, navigating below the fascial layer.
4. The bone cyst or benign tumor is excised using specialized surgical instruments.
5. If needed, an autograft is harvested from another site on the patient’s body and placed into the defect left by the cyst or tumor removal.
6. The area is thoroughly inspected for hemostasis (stoppage of bleeding).
7. The incision is closed in layers, ensuring proper alignment and structural support.
8. The wound is dressed and bandaged.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity and extent of the cyst or tumor.

Setting

The procedure is usually performed in a hospital or surgical center with facilities for general anesthesia and postoperative care.

Personnel

• Orthopedic surgeons or specialized bone surgeons
• Anesthesiologists
• Surgical nurses and technicians
• Radiologists (for intraoperative imaging if needed)

Risks and Complications

• Infection
• Bleeding or hematoma formation
• Nerve or blood vessel injury
• Non-union or delayed healing of the graft site
• Recurrence of the cyst or tumor
• Anesthetic complications

Benefits

• Relief from pain and discomfort caused by the cyst or tumor.
• Prevention of fractures or structural deformities in the bone.
• Improved function and mobility.
• Reduced risk of complications associated with untreated bone growths.

Recovery

• Initial postoperative pain and swelling are managed with medication and ice packs.
• Instructions for wound care and signs of infection to watch for.
• Restricted weight-bearing on the affected limb for a period as determined by the surgeon.
• Follow-up appointments to monitor healing and remove sutures if necessary.
• Physical therapy may be recommended to restore strength and function.

Alternatives

• Conservative treatments such as pain management, physical therapy, and monitoring with regular imaging.
• Minimally invasive procedures (e.g., needle aspiration or biopsy).
• Each alternative has its respective pros and cons, such as lower risk versus lower effectiveness in some cases.

Patient Experience

During the procedure, the patient will be under general anesthesia and unaware of the process. Postoperatively, they will experience some pain and discomfort at the surgical and graft donor sites, which is managed with medication. The patient will need to follow postoperative care instructions and attend follow-up appointments to ensure proper recovery and healing. Physical therapy might be needed to regain full function and strength.