synonyms:ganglion cyst excision
Ganglion Cyst Excision CPT
Ganglion Cyst Excision Indications
- Painful ganglion which has failed conservative management
Ganglion Cyst Excision Contraindications
Ganglion Cyst Excision Alternatives
- Conservative care
Ganglion Cyst Excision Pre-op Planning
Ganglion Cyst Excision Technique
Ganglion Dorsal Ganglion Technique
- Supine, arm board, +/-antibiotics, turniquet, 3.5x loupe magnification
- Transvers incision along Langer’s lines
- Skin hooks for retraction, iris/tenotomy scissors
- Mobilze circumferentially, retract extensor tendons(usually 4thcompartment)
- Identify pedicle, dissect to origin(usually scapholunate ligament)
- Excise portion of dorsal wrist capsule and small portion of scapholunate ligament with pedicle.
- Irrigate wound
- Sub-q closure, skin closure
- 5cc 5% bupivicaine for post-op pain
- Dorsal/palmar splint
Ganglion Volar Ganglion Technique
- 65% arise form radioscaphoid joint near scapholunate interval, 34% from scaphotrapezial joint, 1% trapeziometacarpal joint.
- Usually located radial to FCR tendon
- Dissection may involve the palm, carpal tunnel, even dorsum of wrist due to extent of cyst
- Protect palmar cutaneous branch of the median nerve and terminal branches of lateral antebrachial cutaneous nerve.
- Follow ganglion down to its origin and excise with small portion of capsule.
- 30% chance of recurrence.
Ganglion Cyst Excision Complications
- Nerve injury
- Decreased motion
- We discussed the risks of ganglion excision including but not limited to: incomplete relief of pain, incomplete return of function, cosmesis (scar), infection, nerve or vascular injury, stiffness, wrist instability, CRPS and the risks of anesthesia including heart attack, stroke and death.
Ganglion Cyst Excision Follow-up care
- Post-op: volar splint
- 7-10 Days: wound check. Place in cock-up wrist splint for 2 weeks followed by gradual
- 3 Weeks:
- 6 Weeks:
- 2 Months:
- 3 Months:
- 6 Months:
Ganglion Cyst Excision Outcomes
- @15% recurrence risk after dorsal ganglion excision
- @30% recurrence risk after volar ganglion excision
Ganglion Cyst Excision Review References
- Thornburg LE, JAAOS 1999;7:231