PMC5377428_01
Surgery scars and multiple tumors showed on the right wrist.
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At physical examination, a surgical scar showed on the ulnar side of the right wrist, and multiple tumors was slightly hard (Fig. 1).
a, X-rays showed multiple tumors in the ulnar and palmaris of wrist. The distal of ulna was about 8 mm long than that of radius. b, MR suggested tumor invasion of the deep and superficial flexor tendons.
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Additionally, the distal of ulna was about 8 mm long than that of radius (Fig. 2a). Magnetic Resonance (MR) suggested tumor invasion of deep and superficial flexor tendons (Fig. 2b).
a The primary incision; b Invasion of the ulnar nerve; c Diffuse hyperplasia and ferruginous deposition; d Invasion of the deep and superficial flexor tendons; e The released tumors; f The absorbable suture and the postoperative image.
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The primary incision (Fig. 3a) was performed under satisfied brachial plexus anesthesia. After dissection, the multiple tumors had complete capsule and soft tissue was diffuse hyperplasia (Fig. 3c), which was presented as ferruginous deposition and invaded ulnar nerve, the deep and superficial flexor tendons (Fig. 3b, d). Then the ends of the absorbable suture was tightened and knoted to make two buttons against the radius and ulna surface and to hold the ulnar head in the concavity of the sigmoid notch (Fig. 3f).
a Drill the hole; b The four strands were through the drilled hole; c Tighten the ends of the absorbable suture to make the two buttons against the radius and ulna surface.
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Schematic diagram of technique principles showed as Fig. 4.
a Postoperative X-rays showed normal relation between the ulna and radius. b At one year follow-up, MR showed no tumor recurrence.
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Postoperative X-rays showed normal position between the ulna and radius (Fig. 5a). At one year follow-up, MR showed no tumor recurrence (Fig. 5b).