gms | German Medical Science

43. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen e. V. (DGPRÄC), 17. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen e. V. (VDÄPC)

13.09. - 15.09.2012, Bremen

A retrospective clinical study on open excision of wrist ganglia

Meeting Abstract

  • presenting/speaker S. Stahl - Berufsgenossenschaftliche Unfallklinik Tübingen, Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, Tübingen, Germany
  • P. Hentschel - Berufsgenossenschaftliche Unfallklinik Tübingen, Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, Tübingen, Germany
  • D. Vida - Berufsgenossenschaftliche Unfallklinik Tübingen, Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, Tübingen, Germany
  • O. Lotter - Berufsgenossenschaftliche Unfallklinik Tübingen, Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, Tübingen, Germany
  • H.-E. Schaller - Berufsgenossenschaftliche Unfallklinik Tübingen, Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, Tübingen, Germany

Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen. Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen. 43. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 17. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC). Bremen, 13.-15.09.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocEHIIP03

DOI: 10.3205/12dgpraec186, URN: urn:nbn:de:0183-12dgpraec1864

Published: September 10, 2012

© 2012 Stahl et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objectives: Although controversially discussed, open excision remains one of the most common forms of treatment of wrist ganglia. The purpose of our study was to evaluate the outcome of wrist ganglion excision and patients’ satisfaction.

Methods: 187 patients, treated with open excision of a wrist ganglion between 2003 and 2010, could be identified in the electronic database of our clinic. Patients with a minimum of 6 months follow up, a written consent, and a complete case report form were included in a retrospective study. In a standardized interview epidemiological data, comorbidities, profession, leisure activities and subjective outcome (DASH: Disability of Arm-Shoulder-Hand, PSAS: Patient Scar Assessment Scale, pain on the VAS: visual analogue scale) were assessed. Clinical examination included ROM (range of motion), grip strength and scar assessment (OSAS: Observer Scar Assessment Scale). Complications, surgeons experience and anatomical location and time off work were evaluated from the medical chart.

Results: 75 patients could be interviewed and examined on average 54 months after surgery. 14 could not be traced, two had died, 7 declined participation because of being pain free or because of a lack of interest and 91 did not respond at all. At the time of surgery, the patients were on average 39 years old (range 7 to 71 years; sex ratio: 0.33). The overall occurrences of wrist ganglia were as follows: 54% dorsal; 6% palmar; 10% radio-dorsal and 28% radio-palmar. Patients requested surgery because of pain (79%), stiffness (66%), unsightliness (36%), fear of malignancy (14%) or other reasons (8%).

The PSAS average was 15 out of 60 points (median: 13; min: 7; max: 45 points). POSAS averaged 28.9 out of 120 points (median: 27; min: 14; max: 76 points). At follow up examination pain averaged 2 points at rest (median: 2; min: 0; max: 6 points) and 4 points under strain (median: 4; min: 0; max: 8 points) on the VAS. When operated on the non-dominant hand, grip strength reached 93% relative to the contralateral side, on the dominant hand respectively 105%. Average total active extension-flexion arc was 129° compared to the contralateral wrist 128°.

The overall recurrence rate averaged 20%. Wrist ganglia recurred on average 24 months after surgery (8% after 6 months). Total complication rate was <3% (bleeding 1%, wound infection 2%). Time off work averaged 2.5 weeks (median: 2; min: 1; max: 6 weeks). 95% of the patients would undergo the same surgical procedure again. 69% of all patients reporting to have suffered pain before the surgery were pain free.

Conclusions: Despite moderate response rates for study participation, this study was able to determine benefit, risk and complications of one of the largest case series of wrist ganglia excisions by systematic and standardized data collection. Open excision of wrist ganglia was associated with a high patient satisfaction, minimal complication and low recurrence rate.