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Double Y or H Incisions for Excision of “Giant” Giant Cell Tumors of the Tendon Sheath; Report of 30 Cases
Melissa S. Arief, MD, MHS; Mukund Patel, MD; SUNY Downstate Medical Center
Long Island College Hospital at SUNY Downstate, Brooklyn, NY, USA

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Giant cell tumors of the tendon sheath (GCT TS) are the second most common tumor of the hand. Recurrence of these tumors continues to be an unresolved issue, reported to be between 9-44% of tumors. Incomplete surgical excision is thought to be one of the causes of local recurrence. This study offers a series of cases performed with two novel incision methods called the “double Y” and “H”. These two incisions create a “trap door” style incision allowing complete visualization of the operative field for meticulous dissection. There are no corners or difficult to expose areas as with the standard longitudinal or Brunner incision. This is ideal for fully excising “giant” GCT TS. Each of the flaps has adequate vascular supply minimalizing the risk of wound necrosis. This case series offers 30 cases collected over the course of 4 years with masses of the fingers and hand that were pathologically confirmed as GCT TS. Ten of the cases involved the flexor side of the finger, 10 encroached the mid-lateral margin of the finger from the flexor side, five encroached three adjacent sides of the finger and five were large tumors on the dorsal side of the distal interphalangeal joint. Minimal follow up time for each patient was 1 year and there have been no recurrences and no wound complications. The results of these cases support that these incisions may be a reasonable alternative to the classical Brunner’s incision for excision of these GCT TS.

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