Baker’s Cyst 

Principles Governing Skin Incisions.

·         Always place the incision in the most inconspicuous place possible (ideally where the incision is not visible).

·         A key determinant of scarring is the amount of tension across the wound.

·         Tension can be minimized by placing incisions parallel to relaxed skin tension lines (RSTLs)

·         If there is a possibility that the patient may need a local or regional flap, place the incision so that it does not limit the design of a flap.

·         If an incision must cross a joint surface, the direction of the incision should be altered so a linear contracture does not develop that may restrict joint motion.

·         An incision placed across a joint in an oblique or transverse fashion will lengthen the overall scar and change the direction of wound contracture to optimize range of motion.

(Schwartz 8^th Ed

Operative Technique

·         Make a slightly oblique incision over the medial aspect of the popliteal space; a common error is to place this incision too far proximally.

·         Incise the deep fascia; the proper plane for dissection is the usually evident.

·         Develop the interval between the semimembranosus and the medial head of gastrocnemius and separate the cyst wall from these structures.

·         No important nerves or vessels lie in this plane of cleavage.

·         Often the base of the cyst is intimately attached to the capsule and synovium

·         Small opening may be located if desired by injecting air or PNSS with methylene blue through the posterior part of the capsule into the joint but closing any opening in the joint capsule is probably unnecessary.

·         After excising the cyst, the base is closed by continuous interlocking using an absorbable suture ( viryl 0 round )

·         Skin is closed.

( Cambell’s Operative Orthopaedics  6^th ED)