Name of the Procedure:

Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (e.g., cyst or ganglion); toe(s), each

Summary

In simple terms, this procedure involves surgically removing a growth or lesion on a tendon, tendon sheath, or joint capsule in the toe. This can include cysts or ganglions, which are noncancerous lumps that can cause pain or discomfort.

Purpose

This procedure addresses conditions like cysts, ganglions, or other lesions that form on tendons, tendon sheaths, or joint capsules in the toe. The goal is to relieve pain, improve toe function, and prevent further complications from the lesion.

Indications

• Persistent pain in the toe
• Swelling or lump that does not improve with conservative treatments
• Reduced range of motion in the toe
• Symptoms interfering with daily activities or footwear
• Diagnosis of cyst or ganglion confirmed by imaging studies

Preparation

• Follow fasting instructions if general anesthesia will be used (typically 6-8 hours prior)
• Adjust certain medications as advised by the doctor (e.g., blood thinners)
• Pre-procedure diagnostic tests, such as MRI or ultrasound, to locate and evaluate the lesion

Procedure Description

1. The patient is positioned comfortably and the targeted toe is sterilized.
2. Local anesthesia is commonly used to numb the area, but general anesthesia may be used for multiple or large lesions.
3. An incision is made over the lesion.
4. The lesion is carefully dissected and removed along with any affected tendon sheath or capsule.
5. The incision is closed with sutures and dressed.
6. A splint or bandage may be applied to immobilize the toe temporarily.

Duration

The procedure typically takes about 30 minutes to 1 hour.

Setting

This procedure is usually performed in an outpatient surgical center or hospital.

Personnel

• Orthopedic surgeon or podiatrist
• Anesthesiologist (if general anesthesia is used)
• Surgical nurse or assistant

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Recurrence of the lesion
• Stiffness or limited movement in the toe
• Adverse reactions to anesthesia

Benefits

• Relief from pain and discomfort
• Improved toe function and mobility
• Removal of unsightly lumps
• Prevention of complications from untreated lesions

Recovery

• Keep the foot elevated to reduce swelling
• Follow postoperative instructions, including wound care and any prescribed medications
• Limit weight-bearing activities for several days to weeks
• Full recovery typically takes a few weeks, but this depends on the extent of the surgery
• Follow-up appointments to monitor healing and remove stitches if necessary

Alternatives

• Observation and monitoring for symptom changes
• Aspiration of the cyst (removing fluid with a needle)
• Corticosteroid injections to reduce inflammation
• Physical therapy to manage symptoms
• Pros: less invasive, can be effective for smaller lesions
• Cons: may not provide permanent relief, higher recurrence rates

Patient Experience

During the procedure, the patient may feel pressure but should not feel pain due to anesthesia. After the procedure, there may be tenderness, swelling, and a need for pain management. Comfort measures include prescribed pain relief, icing, and keeping the foot elevated.