[An improved surgical strategy and treatment outcome of dorsal wrist ganglion].

OBJECTIVE: To investigate the clinical outcome of treating dorsal wrist ganglion with an improved surgical strategy by excising the ganglion completely along their stalk and repairing the dorsal carpal ligaments under brachial anesthesia.

METHODS: From March 2005 to January 2007, 34 patients with dorsal wrist ganglion were treated and studied retrospectively. There were 14 males and 20 females, aged 25-65 years (43 years on average). The left sides were involved in 22 cases and right sides in 12 cases. Thirteen cases of relapse received excision for 1 to 4 times under local anesthesia, with a mean period of 17 months (14 days to 7 years) from excision to recurrence. Twenty-one patients were first attack cases with a mean period of 11 months (15 days to 8 years) from diagnosis to excision. The size of the ganglion ranged from 1.5 cm x 1.2 cm to 4.5 cm x 4.0 cm. Now, each surgical process was performed under brachial anesthesia, and a pneumathode tourniquet was used. In 6 patients, the stalks of ganglion did not invade the carpal ligaments, and ganglion was removed completely without immobilization after operation. In 28 patients, the stalks of ganglion invaded the carpal ligaments, ganglion was excised completely along its stalk to the dorsal carpal structure; the ligaments were sutured directly in 16 cases and were repaired with adjacent tissue such as the wall of sheathing canal of extensor tendon in 12 cases. The wrists were immobilised for 3 weeks.

RESULTS: Primary wound healing was achieved in all incisions. All patients were followed up for 26-36 months with an average of 31.5 months. Only 2 cases (5.9%) recurred. The range of motion of the wrist remained normal and the symptom of the dorsal wrist was relieved slightly. Patients' satisfaction score ranged from 60 to 100, with an average of 83.8.

CONCLUSION: The ganglion should be excised completely together with defect repair of dorsal carpal ligament under brachial anesthesia and the wrist immobilised for 3 weeks, the recurrence rate will be reduced greatly.