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.