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Surgical Excision of the Ganglion
The definitive treatment for a ganglion mass
is surgical excision. The surgical excision of a ganglion can be
performed under a local anesthesia, intravenous anesthesia or a general
anesthesia. It is generally performed in an outpatient surgery center.
Under some circumstances the procedure may be performed in the
physicians office. Following administration of anesthesia an incision
is placed centered over the mass. Care must be taken to protect any
skin nerves in the area. The mass is dissected from the surrounding
soft tissues and removed. The ganglion mass has a tail that extends
from the joint or tendon sheath that it arises from. During the
dissection of the mass the tail is identified. Once the tail has been
identified and cut the area of exit from the joint or tendon sheath is
closed with suture or electrocautery. Following the placement of
sutures to close the surgical site a gauze compressive dressing is
applied. In some instances the surgeon will apply a splint or below the
knee cast. Recovery Period The
recovery period depends upon the location of the ganglion and the
amount of dissection required removing it. In many instances patients
are placed in a splint or below the knee cast following the surgical
procedure. The surgeon may require the patient to use crutches for
several days to up to three weeks. This level of protection may be
necessary if the ganglion is near the ankle joint. Movement of the
ankle can cause undue stress on the surgical site and delay healing or
increase the risk of scaring in the area or recurrence of the mass. The
patient is seen for their first follow up visit in 3to 7 days. During
this period of time the patient must stay off of the foot, keeping it
elevated above the heart. On the first visit the surgeon checks the
surgical site and the bandage is reapplied. The sutures are removed in
10 to 14 days following the day of surgery. If a cast or crutches are
not necessary the patient is allowed to return to loose fitting shoes
within two weeks of the surgery. Limited activity is recommended for a
minimum of three to four weeks. The time required to be off from work
will depend upon the demands of the job and the shoes required for
work. In the best of circumstances the patient should remain off from
work for a minimum of one week. Quite often the patient will be
required to be off from work two to three weeks or longer. If the
patient can return to work while wearing a cast they may be able to
return in a shorter period of time. It may take up to six weeks before
a patient may return to exercise or sporting activities. Possible Complications Overall
the surgical procedure is safe and without complications. However, as
with any surgical procedure there are possible complications. The
possible complications associated with the removal of a ganglion
include infection, excessive swelling with delays in healing, damage to
surrounding skin nerves or recurrence of the ganglion. It is important
that during the period of time that the sutures are in place the foot
be kept dry. Moisture will increase the risk of infection.
Additionally, it is important the patient stays off the foot and keeps
it elevated during the first week to ten days following the surgery.
Excessive swelling at the surgical site will lead to delays in the
healing process and promote excessive scaring. Excessive movement at
the surgical site may weaken the deep sutures and increase the risk of
recurrence of the ganglion. On occasion while removing the mass it may
be necessary to sacrifice one of the small skin nerves in the area of
the surgery. In fact, it is not uncommon for one of these nerves to be
invested into the ganglion. When this is the case the nerve must be cut
in order to remove the ganglion. When the nerve is cut, it will result
in a small area of numbness on the top of the foot. Generally, this
does not cause a long-term problem. If excessive swelling or scaring
occurs at the surgical site one of the small skin nerves may become
caught in the scar tissue and result in pain following the surgery.
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