gms | German Medical Science

Objectives/Interrogation: Giant cell tumor of tendon sheath (GCTTS) is a common benign soft tissue tumor in the hand. Its feature is a solid growth on both, the palmar and the dorsal aspect of the finger. High recurrence rates, reported up to 45% in the literature, associated with multiple excisions, and the close contact of GCTTS to valuable structures might provoke collateral damage and diminish finger function. The aim of our study was to evaluate functional outcome following recurrent GCTTS excision on the digits. Procedural risk factors in surgery were analyzed in our own patient collective.

Methods: Monocentric retrospective study with clinical follow up. Patients with GCTTS on the digits operated from 01/2009 to 12/2017 were screened for inclusion criteria. Patient specific and procedural parameters were analyzed. Functional outcome was evaluated with the Ten Test, the two-point discrimination, the range of motion, the DASH score, and VAS for pain. Tumor recurrence was evaluated by clinical and sonographic examination.

Results and Conclusions: A total of 21 patients were operated in our clinic. 20 patients (14 females, 6 males, mean age 56 [25 to 90] years) were included (13 primary tumors, 7 recurrent tumors [4x1st, 2x2nd, 1x6th recurrence]), 1 patient with a fresh injury caused by a slicer was excluded. Digital block anesthesia was used in 4 cases, brachial plexus block or general anesthesia in 16 cases. OP-time was on average 45 [7 to 90] minutes. 5 patients had revision surgery (25%) (3 recurrent tumors [15%, 1x1st, 1x3rd and 1x7th recurrence], 1 neuroma, 1 scar). The patient with 7th recurrence of GCTTS wished for amputation of the digit. The follow-up examination (mean 46 [12 to 112] months post-OP]) highlighted a significantly (p<0.05) impaired functional outcome in patients with recurrence compared to primary tumor excisions. In recurrent tumor patients, sensitivity was diminished in 7 out of 8 patients (Ten test mean 5/10 [3/10 to 7/10], 1 amputation), movement was reduced in 6 out of 8 patients (max. deficit in extension 40° (2/8), max. deficit in flexion 50° (3/8), 1x ankylosis of the DIP joint, 1x amputation). In 12 patients with primary surgery, sensitivity was diminished in 1 patient (Ten test 5/10), movement in 2 patients (max. deficit in extension 30° (1/12), max. deficit in flexion 40° (1/12)). DASH score and pain on VAS were in normal range in all but one patient with finger amputation. Short operation time and digital block anesthesia were associated with high risk for revision surgery.