Tendon sheath cyst concept: the outer wall of the cyst wall is composed of fibrous tissue, the inner wall is similar to the synovial membrane, the cyst is filled with colorless and transparent gel-like mucus, it is caused by mucus-like degeneration of the excess connective tissue in the joint capsule or tendon sheath, the cyst cavity can be connected with the joint cavity or tendon sheath, but there are also closed cases that are not connected with the joint cavity and tendon sheath.
Method 1, the cyst has a relatively large “root” connected to the joint cavity, this case can be used to simply cut the cyst wall, drain the cyst fluid, open the cyst wall and sew into the surrounding soft tissue. However, some people think that this is the regular method and suggest that the cyst wall should be stripped completely and the base connected with the joint cavity should be exposed as much as possible and then turned over, otherwise there is still a possibility of recurrence.
The second method, the use of non-surgical aspiration therapy for the treatment of tendon sheath cysts, simple operation, less damage, not easy to recur, the specific operation is this: with 1% lidocaine injection 2 ~ 3 ml in the cyst local intradermal, subcutaneous infiltration anesthesia. The right hand takes a 16-gauge sterile needle and punctures the cyst from the center of the tendon sheath cyst, and extracts the gelatinous fluid from the cyst by suction (pumping with saline to make the contents dilute and easy to pump), and then injects the “closure solution” into the cavity of the tendon sheath cyst, which is very effective and not easy to recur.
The advantage is that it does not leave a scar, easy to operate, the simplest is 1 by the patient is not ready to force pinch cyst, and then asked the patient to massage the cyst several times a day, so that the cyst wall effective adhesion, stop the production of mucus, 2 or with a thick book to break the cyst, these two methods are best used in familiar people, the general patient may occur misunderstanding, in addition to the recurrence rate high.
Method 4, a few cysts are more independent and can be removed completely, which is the most reassuring.
Specific methods can be referred to.
1.After applying a tourniquet and local anesthesia, a transverse incision or a longitudinal “S” or curved incision is made, and the skin and subcutaneous area are incised;
2.Find the cyst, first do a certain degree of subtle sharp separation of the surrounding tissues, then from superficial to deep, from easy to difficult, peel out most of the cyst, and generally figure out the scope of the cyst and the compartment;
3.After actively breaking the cyst wall and clearing the cyst fluid, the space occupied by the cyst in the body becomes obviously smaller, and the partition and “cyst neck” can be seen clearly from inside the cyst, so that it is easy to probe deeper and peel off and remove the cyst wall completely;
4. Loose tourniquet, suture and ligation of obvious bleeding points, and layered suturing of subcutaneous and skin. Appropriate pressure bandage is applied and the operation is completed.
Method V. For smaller (less than 3 cm in diameter) tendon sheath cysts are treated using sutures.
The specific methods are as follows.
1.Local infiltration anesthesia is performed around the tendon sheath cyst that can be palpated.
2, using a large angle needle, No. 4 or No. 7 gauge.
3, use two fingers of one hand to fix the cyst, and then use an angled needle to cross the bottom of the cyst with a percutaneous suture from one side of the cyst to the other end.
4.Lift the sutures at both ends, then enter the needle again from the exit point and sew through the upper 1/4 of the cyst wall to the exit point at the other end, tighten the sutures, tie the knot, cut the thread, and bury the knot under the skin, thus completing a suture.
5, and then every 120 degrees angle and then a needle, a total of three stitches can be.
6, after surgery to slightly force massage cysts, can make the cysts within the synovial fluid out (conditional on the use of semiconductor or ultra-laser irradiation treatment, once a day, 3 to 5 times. Can significantly reduce the situation of Article 7 (because the semiconductor laser or ultra-laser on the tissue adhesion edema, pain, granulation tissue regeneration is a very good clinical effect).
7, a week after the operation will have local swelling occurs, mainly caused by the stimulation of synovial fluid.
8.After the local swelling subsides, the cyst will go down naturally.
This method is more effective, without incision, simple operation, but it is a little difficult to grasp the position of the cyst when you first use it, do it a few more times and you will be fine. There are also recurrences, but the recurrence rate is relatively low, I have not done specific statistics.
The principle of using this method is mainly that the suture can puncture the cyst so that the cystic fluid can flow out, and the suture that stays in the cystic cavity is a foreign body that can stimulate the cystic wall tissue to produce adhesions.
Method 6, puncture with a 20ml syringe needle, try to extract the cystic fluid, then fill the cystic cavity with saline, then introduce a surgical suture with lamb’s intestine thread inside the cystic cavity through the end of the needle, stuff it until the resistance is relatively large when the needle is withdrawn, cut off the thread exposed outside the skin, so that the lamb’s intestine thread remains in the cystic cavity, and the cystic wall will be adhered.