Ozcanli Haluk, Ozaksar Kemal, Cavit Ali, Gurer Elif Inanc, Cevikol Can, Ada Sait
1 Department of Orthopaedics, Faculty of Medicine, Akdeniz University, Antalya, Turkey.
2 Hand Microsurgery Orthopaedics and Traumatology (EMOT) Hospital, Izmir, Turkey.
J Orthop Surg (Hong Kong). 2019 May-Aug;27(2):2309499019840736. doi: 10.1177/2309499019840736.
Deep palmar tumors of the hand are very rare, and reported cases are usually benign. The most important issue is frequent anatomical variations with challenging surgical exposure and excision of these lesions. Some case reports or a small series of patients have been reported in the literature. The aim of this study was to present our experience with the deep palmar tumors of the hand.
In the study, retrospective analyses of 43 patients treated with deep palmar tumors of the hand between January 1998 and June 2015 were evaluated. Tumors and tumor-like pathologies of the deep palmar space of the hand were retrospectively evaluated according to age, gender, localization, preoperative symptoms, size, site, treatment methods, histopathology, and early and late complications. Statistics and data analyses were also performed.
All 43 pathologies were benign, and histopathologic diagnoses were 10 lipomas, 8 ganglions, 5 giant cell tumor of the tendon sheath, 4 schwannomas, 3 hemangiomas, 3 palmar fibromatosis, 2 epidermal cysts, 2 neurofibroma, 1 angiolymphoid hyperplasia with eosinophilia, 1 granuloma, 1 calcifying aponeurotic fibroma, 1 digital fibroma, 1 foreign body granuloma, and 1 lipofibromatous hamartoma. The most common complication was temporary numbness and paresthesias of the digits. Marginal excision was performed in 40 patients, excision with nerve grafting in 2 patients (with neurofibroma) and carpal tunnel release in one patient with lipofibromatous hamartoma.
In the deep palmar space of the hand, pathologies are closely associated with tendons, muscles, and neurovascular structures. Preoperative magnetic resonance imaging is helpful for the preoperative diagnosis, evaluating tumor extension, and successful surgical planning. Level of Evidence: IV Therapautic.
手掌深部肿瘤非常罕见，已报道的病例通常为良性。最重要的问题是频繁的解剖变异，这给这些病变的手术暴露和切除带来挑战。文献中已有一些病例报告或小样本患者系列报道。本研究的目的是介绍我们治疗手掌深部肿瘤的经验。
本研究对1998年1月至2015年6月间接受手掌深部肿瘤治疗的43例患者进行回顾性分析。对手掌深部间隙的肿瘤及肿瘤样病变，根据年龄、性别、部位、术前症状、大小、位置、治疗方法、组织病理学以及早期和晚期并发症进行回顾性评估。同时进行统计和数据分析。
43例病变均为良性，组织病理学诊断为10例脂肪瘤、8例腱鞘囊肿、5例腱鞘巨细胞瘤、4例神经鞘瘤、3例血管瘤、3例掌纤维瘤病、2例表皮样囊肿、2例神经纤维瘤、1例嗜酸性粒细胞增多性血管淋巴样增生、1例肉芽肿、1例钙化性腱膜纤维瘤、1例指纤维瘤、1例异物肉芽肿和1例脂肪纤维瘤性错构瘤。最常见的并发症是手指暂时麻木和感觉异常。40例患者行边缘切除，2例（神经纤维瘤患者）行神经移植切除，1例脂肪纤维瘤性错构瘤患者行腕管松解术。
在手掌深部间隙，病变与肌腱、肌肉和神经血管结构密切相关。术前磁共振成像有助于术前诊断、评估肿瘤范围及成功的手术规划。证据级别：IV治疗性。
