Surgery for ganglia of the flexor tendon sheath

Abstract

There are very few reports in the literature on the results of surgery for ganglia of the flexor tendon sheaths of the digits. We reviewed 24 patients operated for flexor tendon sheath ganglia 8 (3–11) years previously. Two operations were for recurrences and one of these recurred again. There was one permanent digital nerve injury and one patient complained of cold sensibility. VAS (0=best; 100=worst) for mean general complaints from the hand was remembered as 51 before surgery and was 5 at review. Mean pain at review was reported as VAS 4 and general satisfaction with the operation as VAS 3. All stated that they would have consented to surgery if they had known the outcome in advance. We conclude that the results of surgery are good, although complications do occur.

Dorsal and volar wrist ganglions: The results of surgical treatment

“…6 Other authors used horizontal as well as transverse incisions in operative treatment of dorsal wrist ganglions, without noticeable differences in wound healing. 1,19 Our observations regarding this aspect are similar. The use of either of the 2 approaches did not influence scar formation in our patient group.…”

“…According to different authors, recurrence rate ranges from 1% to almost 50%. 1,6,9,10,12,14,18,19,[21][22][23][24][25] The frequency of ganglion recurrence observed in our patient group (12.1% for dorsal wrist ganglions and 10.4% for volar wrist ganglions) is acceptable. Huge differences in recurrence rates reported by different authors are the result of the heterogeneity of the studied patient groups, including different numbers of patients included in particular studies, varying postoperative follow-up periods, as well as different levels of surgeon experience, etc.…”

“…14 The incidence of this complication varies from 1% to 20% in the literature. 14,19 In order to decrease the risk of arterial injury, Lister and Smith suggested a modification of the operative technique, in which a fragment of the cyst wall closely connected with the artery is retained. 20 This complication cannot always be prevented, despite the awareness of the risk of arterial injury associated with the dissection of volar wrist ganglions, as in the case of the 3 patients who suffered such a complication in our patient group.…”

“…1,6 At the same time, the comparison of different methods used in the treatment of ganglion cysts (observation, aspiration, administration of an obliterating agent into the cyst, operative management) reveals that the highest patient satisfaction is associated with surgical treatment, even in the cases in which recurrence occurred. 19,21 Operative treatment allows for fast tumor removal and carries a lower risk of recurrence than other methods. 19,21 Arthroscopic treatment can constitute an alternative to open surgery.…”

Ganglions of the hand and wrist: Retrospective statistical analysis of 520 cases

“…At least several theories aimed at explaining ganglion pathophysiology exist but all of them have certain weaknesses. 12,15,[23][24][25][26] The first of these theories suggests that a ganglion is a herniation of the joint capsule (herniation of the synovial tissue from the joint). According to this concept, the fluid filling the cyst would originate from the joint and would be pumped into the cyst through a one-way valve mechanism.…”