Name of the Procedure:

Excision or Curettage of Bone Cyst or Benign Tumor, Tarsal or Metatarsal (Except Talus or Calcaneus)

Summary

This surgical procedure involves the removal (excision) or scraping (curettage) of a bone cyst or benign tumor from the bones in the midfoot (tarsal) or the bones of the toes (metatarsal), excluding the talus or calcaneus bones.

Purpose

The procedure addresses benign bone growths or cysts that may cause pain, discomfort, or potential fractures. The goal is to remove the abnormal growth while preserving as much healthy bone as possible to restore normal foot function and alleviate symptoms.

Indications

• Presence of a bone cyst or benign tumor in the tarsal or metatarsal bones
• Symptoms such as localized pain, swelling, or restricted movement
• Risk of fracture due to the bone lesion
• Failure of non-surgical treatments to resolve symptoms

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Adjustments to medications, particularly blood thinners, may be necessary.
• Imaging tests, such as X-rays or MRIs, are performed to assess the cyst or tumor.

Procedure Description

1. The patient is administered anesthesia, typically regional or general, to ensure comfort.
2. A surgical incision is made over the affected area.
3. The surgeon carefully accesses the bone and identifies the cyst or tumor.
4. Excision or curettage is performed to remove the abnormal tissue.
5. Bone grafts or other materials may be used to fill the void left by the removed tissue.
6. The incision is closed with sutures or staples.
7. A sterile dressing is applied, and the foot is often immobilized with a cast or splint.

Duration

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

Setting

The surgery is usually performed in a hospital or outpatient surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

• Infection
• Bleeding
• Damage to surrounding structures, including nerves or blood vessels
• Incomplete removal of the cyst or tumor
• Fractures or weakness in the bone
• Recurrence of the cyst or tumor

Benefits

• Relief from pain and discomfort
• Prevention of fractures and other complications
• Restoration of normal foot function Benefits are typically realized within several weeks to months as the bone heals.

Recovery

• Post-operative care involves keeping the foot elevated and avoiding weight-bearing activities.
• Pain management might include medications and ice application.
• Follow-up appointments are necessary to monitor healing.
• Physical therapy may be recommended to restore full functionality.
• Recovery time can range from several weeks to a few months, depending on the extent of the surgery.

Alternatives

• Observation and regular monitoring for asymptomatic or small cysts/tumors
• Non-surgical treatments like medication, orthotics, or physical therapy
• Aspiration or injection of the cyst in selected cases

Pros and cons:

• Non-surgical options have lower immediate risk but may not be as effective in symptom relief or preventing complications.
• Excision or curettage offers a more definitive solution but comes with surgical risks.

Patient Experience

• During the procedure, the patient will be under anesthesia and should not feel pain.
• Post-operatively, some discomfort and swelling are expected, which can be managed with pain medication and proper care.
• Full recovery may take several months, and patients will need to follow specific instructions to ensure optimal healing.