Outpatient surgery of benign soft tissue masses in the hand. A retrospective review of 179 patients.

Öz

Objective: Benign soft tissue masses of the hand are more common than malignant and bone derived masses. Most of these can be treated with outpatient surgery. In the present study, we aimed to assess the diagnosis, recurrence rate and the effect of local anesthesia method on the recurrence rate of benign soft tissue masses treated with outpatient surgery. Method: 179 patients with histopathologically confirmed diagnosis of benign soft tissue mass who were treated with outpatient surgery between 2015 and 2020 were retrospectively reviewed. In addition to the demographic characteristics of the patients, the results were analyzed according to the exact diagnosis of the masses, anatomical locations and the local anesthesia method. Results: 96 (53%) patients were female and 83 (47%) were male. The mean age was 41.6 (10-75; SD: 15.1) years and the mean follow-up time was 47.4 (24-82; SD: 11.1) months. The anatomical localization of the mass was most common in the second and third finger rows (21% and 21%, respectively) and at the level of the proximal phalanx (22%). The most common diagnoses were tendon sheath giant cell tumor (27%) and ganglion cyst (16%). The recurrence rate was 6% among all patients. It was observed that 89 (49%) patients were operated under regional intravenous anesthesia (RIVA), and 90 (51%) patients were operated with infiltrative local anesthesia (LA). There was no significant difference in terms of recurrence between these two methods (p=0.546). Conclusion: Benign soft tissue masses of the hand can be successfully treated with outpatient surgery. Recurrence rates were low in our patient series and it was concluded that different local anesthesia methods did not affect the recurrence rate.

Anahtar Kelimeler

• hand
• soft tissue mass
• outpatient surgery

Günübirlik cerrahi ile tedavi edilen el iyi huylu yumuşak doku kitleleri. 179 hastanın geriye dönük incelemesi

Öz

Amaç: Elin iyi huylu yumuşak doku kitleleri, kötü huylu kitlelere ve kemik kitlelerine kıyasla daha sık görülmektedir. Bu kitlelerin büyük çoğunluğu günübirlik cerrahi ile tedavi edilebilmektedir. Bu çalışmada günübirlik cerrahi ile tedavi edilen iyi huylu yumuşak doku kitlelerinin tanı dağılımını, nüks oranını ve lokal anestezi yönteminin nüks oranına etkisini incelemeyi amaçladık. Yöntem: 2015 ve 2020 yılları arasında günübirlik cerrahi ile tedavi edilen ve histopatolojik tanısı iyi huylu yumuşak doku kitlesi olan 179 hasta geriye dönük olarak incelendi. Hastaların demografik özelliklerine ek olarak kitlelerin histopatolojik tanıları, anatomik yerleşim yerleri ve yapılan lokal anestezi yöntemine göre veriler incelendi. Bulgular: Hastaların 96’sı (%53) kadın ve 83’ü (%47) erkek idi. Yaş ortalaması 41.6 (10-75; SS:15.1) yıl ve ortalama takip süresi 47.4 (24-82; SS:11.1) ay idi. Kitlenin anatomik yerleşim yeri en sık ikinci ve üçüncü parmak sıralarında (sırasıyla, %21 ve %21) ve proksimal falanks seviyesinde (% 22) idi. En sık görülen tanılar tendon kılıfı dev hücreli tümörü (%27) ve ganglion kisti (%16) idi. Nüks oranı tüm hastalar arasında %6 olarak bulundu. 89 (%49) hastanın cerrahisi bölgesel intravenöz anestezi (BİVA), 90 (%51) hastanın ise infiltratif lokal anestezi (LA) yöntemi ile yapıldığı tespit edildi. Bu iki yöntem arasında nüks açısından anlamlı bir farklılık bulunmadı (p=0.546). Sonuç: Elin iyi huylu yumuşak doku tümörleri günübirlik cerrahi ile başarılı bir şekilde tedavi edilebilmektedir. Hasta serimizde nüks oranları düşük görülmüş ve seçilen anestezi yönteminin nüks oranına etki etmediği sonucuna varılmıştır.

Anahtar Kelimeler

• el
• yumuşak doku kitlesi
• günübirlik cerrahi

Kaynakça

1. Garcia J, Bianchi S. Diagnostic imaging of tumors of the hand and wrist. Eur Radiol. 2001;11:1470-1482. DOI:10.1007/s003300000751
2. Payne WT, Merrell G. Benign bony and soft tissue tumors of the hand. J Hand Surg Am. 2010;35:1901-1910. DOI:10.1016/j.jhsa.2010.08.015
3. Strike SA, Puhaindran ME. Tumors of the Hand and the Wrist. JBJS Rev. 2020;8(6):e0141. DOI:10.2106/JBJS.RVW.19.00141
4. Athanasian EA. Bones and Soft Tissue Tumors. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, Cohen M Eds. Green’s Operative Hand Surgery. 6th ed. Elsevier: Churchill Livingstone, 2011:2141-2195.
5. Nepal P, Songmen S, Alam SI, Gandhi D, Ghimire N, Ojili V. Common Soft Tissue Tumors Involving the Hand with Histopathological Correlation. J Clin Imaging Sci. 2019;24;9:15. DOI:10.25259/JCIS-6-2019
6. Sobanko JF, Dagum AB, Davis IC, Kriegel DA. Soft tissue tumors of the hand. 1. Benign. Dermatologic Surg. 2007;33:651–667. DOI:10.1111/j.1524-4725.2007.33140.x
7. Nahra ME, Bucchieri JS. Ganglion cysts and other tumor related conditions of the hand and wrist. Hand Clin. 2004;20(3):249-260. DOI:10.1016/j.hcl.2004.03.015
8. Cavit A, Özcanli H, Sançmiş M, Ocak GA, Gürer Eİ. Tumorous Conditions of the Hand: A Retrospective Review of 402 Cases. Turk Patoloji Derg. 2018;34(1):66-72. DOI:10.5146/tjpath.2017.01413

9. Fujibuchi T, Imai H, Miyawaki J, Kidani T, Kiyomatsu H, Miura H. Hand tumors: A review of 186 patients at a single institute. J Orthop Surg (Hong Kong). 2021;29(1):2309499021993994. DOI:10.1177/2309499021993994
10. Tang ZH, Rajaratnam V, Desai V. Incidence and anatomical distribution of hand tumours: a Singapore study. Singapore Med J. 2017;58(12):714-716. DOI:10.11622/smedj.2016147
11. Simon MJ, Pogoda P, Hövelborn F, et al. Incidence, histopathologic analysis and distribution of tumours of the hand. BMC Musculoskelet Disord. 2014;15:182:1-8. DOI:10.1186/1471-2474-15-182
12. Lazerges C, Degeorge B, Coulet B, Chammas M. Diagnosis and treatment of hand tumors. Orthop Traumatol Surg Res. 2022;108(1S):103153. DOI:10.1016/j.otsr.2021.103153
13. Okada K. Points to notice during the diagnosis of soft tissue tumors according to the "Clinical Practice Guideline on the Diagnosis and Treatment of Soft Tissue Tumors". J Orthop Sci. 2016;21(6):705-712. DOI:10.1016/j.jos.2016.06.012
14. Henderson M, Neumeister MW, Bueno RA Jr. Hand tumors: I. Skin and Soft-tissue tumors of the hand. Plast Reconstr Surg. 2014;133:154-164. DOI:10.1097/01.prs.0000436854.09656.05
15. Gude W, Morelli V. Ganglion cysts of the wrist: pathophysiology, clinical picture, and management. Curr Rev Musculoskelet Med. 2008;1(3-4):205-211. DOI:10.1007/s12178-008-9033-4
16. Thornburg LE. Ganglions of the hand and wrist. J Am Acad Orthop Surg. 1999;7:231-238. DOI:10.5435/00124635-199907000-00003
17. Hsu CS, Hentz VR, Yao J. Tumours of the hand. Lancet Oncol. 2007;8:157-166. DOI:10.1016/S1470-2045(07)70035-9
18. Williams J, Hodari A, Janevski P, Siddiqui A. Recurrence of giant cell tumors in the hand: A prospective study. J Hand Surg Am. 2010;35:451-456. DOI:10.1016/j.jhsa.2009.12.004
19. Tang P, Hornicek FJ, Gebhardt MC, Cates J, Mankin HJ. Surgical treatment of hemangiomas of soft tissue. Clin Orthop Relat Res. 2002;399:205-210. DOI:10.1097/00003086-200206000-00025
20. Sardenberg T, Ribak S, Colenci R, Campos RB, Varanda D, Cortopassi AC. 488 hand surgeries with local anesthesia with epinephrine, without a tourniquet, without sedation, and without an anesthesiologist. Rev Bras Ortop. 2018;53(3):281-286. DOI:10.1016/j.rboe.2018.03.011
21. Albrecht E, Mermoud J, Fournier N, Kern C, Kirkham KR. A systematic review of ultrasound-guided methods for brachial plexus blockade. Anaesthesia. 2016;71:213-227. DOI:10.1111/anae.13347
22. Lalonde D, Martin A. Tumescent local anesthesia for hand surgery: improved results, cost effectiveness, and wide-awake patient satisfaction. Arch Plast Surg. 2014;41(4):312-316. DOI:10.5999/aps.2014.41.4.312
23. Bezuhly M, Sparkes GL, Higgins A, et al. Immediate thumb extension following extensor indicis proprius-to-extensor pollicis longus tendon transfer using the wide-awake approach. Plast Reconstr Surg. 2007;119:1507-1512. DOI:10.1097/01.prs.0000256071.00235.d0
24. Nijs K, Lismont A, De Wachter G, et al. The analgesic efficacy of forearm versus upper arm intravenous regional anesthesia (Bier's block): A randomized controlled non-inferiority trial. J Clin Anesth. 2021;73:110329. DOI:10.1016/j.jclinane.2021.110329