PMC8635667_01
Appearance of the right wrist in the first visit to our outpatient clinic.
ICRP_A_1986050_F0001_C.jpg
PMC8635667_01_ICRP_A_1986050_F0001_C.jpg
F0001
A soft tissue defect was observed on the flexor side of the wrist, which exposed the flexor tendon and median nerve (Figure 1).
Contrast-enhanced MRI showing hypertrophy of the synovial sheath on the flexor tendon (arrows) with T2 fat suppression.
ICRP_A_1986050_F0002_C.jpg
PMC8635667_01_ICRP_A_1986050_F0002_C.jpg
F0002
Magnetic resonance imaging (MRI) revealed hypertrophy of the synovial sheath (Figure 2).
Intraoperative photograph. The wound was filled with an inflamed synovial sheath (A). A temporoparietal fascia flap was harvested from the right temporal region. A skin paddle (arrow) was made from the anterior part of the right ear (B). The median nerve was wrapped in the flap and then placed between FDS and FDP (C). A full-thickness skin graft was harvested and grafted onto the flap. Arrow indicate anastomosis sight (D).
ICRP_A_1986050_F0003_C.jpg
PMC8635667_01_ICRP_A_1986050_F0003_C.jpg
F0003
When the dead space was released during surgery, the wound was filled with an inflamed synovial sheath (Figure 3(A)). A TPF flap was harvested from the right temporal region (Figure 3(B)). After wrapping the median nerve with the flap, it was inserted between the flexor digitorum superficialis (FDS) tendon and flexor digitorum profundus (FDP) tendon, and then folded onto the FDS tendon (Figure 3(C)). A full-thickness skin graft was harvested from the abdomen and grafted onto the flap (Figure 3(D)).
The pathological finding of the synovial sheath with HE staining showed epithelioid cell granuloma (A). However, there were no mycobacteria with Thiel-Nielsen staining (B).
ICRP_A_1986050_F0004_C.jpg
PMC8635667_01_ICRP_A_1986050_F0004_C.jpg
F0004
Pathological findings of the resected synovium stained with hematoxylin & eosin (HE) revealed epithelioid cell granuloma (Figure 4(A)); however, Ziehl-Neelsen staining did not show any specific findings (Figure 4(B)).
Appearance of the right wrist 1 year and 10 months after surgery.
ICRP_A_1986050_F0005_C.jpg
PMC8635667_01_ICRP_A_1986050_F0005_C.jpg
F0005
No recurrence has been detected (Figure 5).