Flexor synovectomy:
  • Extensile exposure, forearm, then palm
  • Palmaris longus and median palmar cutaneous branch reflected in flap
  • Dissection from known to unknown - median nerve, finger flexors, FPL, FCR
  • En bloc excision when possible to avoid retained tumor
  • Palm "Y" exposure
  • Carpal tunnel opened
  • Median palmar cutaneous identified
  • Ulnar bursa and flexor sheaths opened
  • Small and ring lumbricals excised because of infiltration, others debrided
  • Caseous debris in midpalmar space
  • Back and forth from each side to access contents deep to superficial palmar arch
  • Radial leaf of transverse retinacular ligament repaired to ulnar edge of superficial palmar fascia
  • Closure without drains.