28107 Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus; with allograft

Name of the Procedure:

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

• Common Names: Bone cyst removal, benign tumor excision, tarsal/metatarsal surgery
• Medical Terms: Excision, Curettage, Allograft

Summary

This procedure involves the surgical removal or scraping out (curettage) of a bone cyst or benign tumor from the foot bones known as the tarsals or metatarsals. It includes the use of an allograft, which is donor bone tissue used to fill the space where the cyst or tumor was removed.

Purpose

• Medical Condition/Problem Addressed: Bone cysts and benign tumors in the foot's tarsal or metatarsal bones.
• Goals/Expected Outcomes: To alleviate pain, prevent fractures, restore normal bone function, and prevent the cyst or tumor from enlarging or causing other complications.

Indications

• Presence of symptomatic bone cysts or benign tumors in the tarsal or metatarsal bones (excluding the talus and calcaneus).
• Pain, swelling, or functional impairment due to the cyst or tumor.
• Increased risk of pathological fractures.
• Diagnosed through imaging studies like X-rays, MRIs, or CT scans.

Preparation

• Pre-Procedure Instructions: Often includes fasting for a certain period before surgery, adjusting current medications as advised by the doctor, and arranging for post-surgery transportation.
• Diagnostic Tests/Assessments: Imaging studies (X-ray, MRI, CT scan), pre-anesthetic evaluation, blood tests.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered for pain management and comfort.
2. Incision: A surgical incision is made over the affected tarsal or metatarsal bone.
3. Excision/Curettage: The surgeon removes or scrapes out the bone cyst or benign tumor.
4. Allograft Placement: Donor bone tissue (allograft) is placed in the space to help in healing and bone regeneration.
5. Closure: The incision is closed with sutures and covered with a sterile dressing.

Tools/Equipment: Surgical instruments for excision/curettage, allograft materials, and imaging guidance tools.

Duration

The procedure typically takes about 1 to 2 hours, depending on the size and location of the cyst or tumor.

Setting

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

Personnel

• Orthopedic Surgeon
• Surgical Nurses
• Anesthesiologist
• Operating Room Technicians

Risks and Complications

• Common Risks: Infection, bleeding, pain, swelling.
• Rare Risks: Nerve damage, blood clots, reaction to allograft material.
• Complications Management: Antibiotics for infection, pain management strategies, and close monitoring by the surgical team.

Benefits

• Pain relief.
• Restoration of normal bone structure and function.
• Prevention of cyst/tumor growth and potential fractures.
• Benefits are typically realized within weeks to months post-surgery.

Recovery

• Post-Procedure Care: Pain management, keeping the surgical site clean and dry, limited weight-bearing, and use of crutches or a walker if needed.
• Recovery Time: Typically, patients can return to normal activities within 6 to 12 weeks with follow-up appointments to monitor healing.

Alternatives

• Other Treatment Options: Observation (if asymptomatic), steroid injections, physical therapy.
• Pros and Cons of Alternatives:
  • Observation avoids surgery but the cyst/tumor may grow.
  • Injections might reduce symptoms but don't remove the cyst/tumor.
  • Physical therapy can improve function temporarily but doesn't address the underlying cyst/tumor.

Patient Experience

• During the Procedure: The patient will be under anesthesia and should not feel any pain.
• After the Procedure: Pain and swelling are expected, managed with medication. Proper wound care, rest, and gradual return to activity as advised by the healthcare team.