Ganglion is commonly encountered problem across all age groups. It is one of the most common soft tissue tumors. Most commonly, patients seek treatment for cosmetic reason. Though there are variety of treatment options available, but very few are effective and cosmetically acceptable. Treatments like aspiration alone or in conjunction with hyaloronic acid or triamcinalone have higher recurrence rates. Hitting with book or bible is of historical significance. Surgical excision is best option available, but, leaves scar behind. In these circumstances, treatment by transfixation by no 1 mersilk suture under local anaesthesia on outpatient basis. This is effective as well as cosmetically acceptable method of treatment. In our series of 32 patients, which were treated by transfixation suture, had minimal complication. Silk used in this method helps in making track for escape of ganglion contents following initial procedure. And retaining suture lets the contents escape out and it produces fibrosis within ganglion lining. Thus reducing the chances of recurrences, compared to plain needling. As we call it "needling" is an excellent method with low recurrence, comparable to surgical excision with success rate of 90%.
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