Outcomes of Surgery for Benign Tumours in The Upper Extremity.

Benign tumours of the upper extremity are common in hand surgeons' practice. The most commonly diagnosed are giant-cell tumours of the tendon sheath and lipomas. THE OBJECTIVE: of this study was an investigation into the distribution of tumours in the upper limb, their symptomatology and outcomes of surgery, particularly regarding the rate of recurrence. MATERIAL AND METHODS: A total of 346 patients, 234 women (68%) and 112 men (32%), who had undergone surgery for tumours located in the upper extremity which were not ganglion cysts were enrolled into the study. The follow-up assessment was performed at a mean of 21 months (range 12-36) post-operatively. RESULTS: The most common tumour in this study was giant cell tumour of the tendon sheath - 96 cases (27.7%), followed by lipoma - 44 cases (12.7%). Most lesions - 231 (67%) were localized in the digits. A total of 79 (23%) recurrences were noted, the most common after surgery for rheumatoid nodules - 43.3% and the giant-cell tumours of the tendon sheath - 31.3%. The independent factors increasing risk of recurrence following the tumour's resection were: histological type of the lesion - the giant-cell tumour of the tendon sheath (p=0.0086) and the rheumatoid nodule (p=0.0027), as well as a combination of incomplete (non-radical) and not "en block" resection of tumours. A brief review of the literature referring to the presented material is offered.

Outcomes of surgery for schwannomas of the upper extremity.

<b>Introduction:</b> Schwannoma is a nerve tumor originating from Schwann-cells of the nerve sheath. It is found in all body regions, the most frequent in the head, neck and in the extremities. </br></br> <b>Aim:</b> The objective of this study was analysis of outcomes of surgery for these lesions in the authors' institution. </br></br> <b>Materials and methods:</b> Results of the treatment of 12 patients, 7 women and 5 men, aged a mean of 40 years with shwannomas localized in the upper limb are presented. The follow-up assessment was performed in a form of telephone interview at a mean of 4.2 years post-operatively. </br></br> <b>Results:</b> The tumors were located in the hand in 5 patients, in the forearm in other 5 and in the wrist in 2. In 3 patients the tumors originated form the median, in 2 from the ulnar and in 2 from the radial nerves; in 5 cases it grew from small nerve branches. All lesions of the median, ulnar and radial nerves were encapsulated without damage of the nerve fascicles, while in the hand they were resected in total. At a mean of 4.2 years of follow-up, two recurrences (17%) occurred, both following resection of the tumor located in the hand. Complications were noted in 5 patients: two felt parasthesiae in the operated finger, two were disappointed due to unaesthetic scar and one patient following tumor resection from posterior interosseous nerve had incomplete finger extension. </br></br> <b>Conclusion:</b> Outcomes of surgery for these rare tumors are generally good, but functional deficits should be considered in cases of lesions involving motoric nerves.

Outcomes of surgery for giant cell tumors of the tendon sheath within the hand.

<b>Introduction:</b> Giant cell tumor of the tendon sheath is the most common benign proliferative lesion involving the upper limb, characterized by relatively high recurrence rate after surgery. <br><b>Aim:</b> The objective of the study was a retrospective analysis of outcomes of the operative treatment of these tumors, in a longterm (a mean of 4,2 year) follow-up. <br><b>Material and methods:</b> Preoperative examination was performed in 58 patients, 36 females (62%) and 22 males (38%), in a mean age of 41 years, and treatment outcomes were assessed in 47 persons (81% of the operated patients), at a mean of 4.2-year follow-up. The final assessment was performed in a form of phone interview. <br><b>Results:</b> The most common site of the tumors was the fingers - 42 cases (72%). In 31 patients (53%) the lesion had a well-defined capsule, and in 11 (19%) a satellite nodule was found around the main tumor. A total of 9 relapses (21%) occurred, all within the first 2 years following surgery. Two patients had a next episode of recurrence after the second operation. In 8 out of the 9 patients with a recurrence, the primary lesion did not have a well-defined capsule. In 38 patients who had no relapse, 31 were completely symptom-free, whereas 7 complained of mild pain of the scar and/or numbness of a part of the involved finger. <br><b>Conclusions:</b> The main factor that impacted the high rate of recurrence was incomplete tumor excision, which resulted from inadequately accurate surgery and the tumor morphology (having no well-defend capsule). The role of operating with the use of magnifying devices and keeping a greater surgical margin at resection of the non-capsulated lesions was emphasized, as it could translate into reducing the recurrence rate.