Perioperative management - Ganglionectomy for palmar wrist ganglion

• Pain
• Movement disorder

• Local or general diseases that contraindicate an elective surgery surgically or anesthesiologically, or are improvable preoperatively

• Clinical Examination:
  → Inspection/palpation of a painful thickening along the course of the radial artery on the flexor side of the wrist
• Sonography: Detection of a fluid-filled cavity connected to the radiocarpal joint, scaphotrapezoid joint, or radioscaphoid joint
• Possibly MRI in case of unclear findings

• no special preparation of the patient necessary
• generally an outpatient procedure
• clarification of contraindication for bloodlessness (e.g., existing shunt in dialysis)

Information about

• surgical method
• additional procedures such as reconstruction of the radial artery, nerve

• general surgical risks
  • wound healing disorder
  • tendon injury
  • functional deficit of wrist/hand
  • CRPS

• specific surgical risks
  • injury to the superficial branch of the radial nerve or lateral antebrachial cutaneous nerve with neuropathic pain
  • injury to the radial artery
  • prolonged scar pain (usually subsides after 6 months)
  • persistent complaints
  • revision surgery
  • risk of recurrence

• intravenous regional anesthesia
• plexus anesthesia
• general anesthesia

• Supine positioning
• Placement of the hand on a hand table
• Recommended application of upper arm tourniquet

• The surgeon should sit on the side where the leading hand points distally with the scissor tip
• Opposite, an assistant may be seated
• The instrument nurse positions themselves at the head of the hand table

• It is recommended to establish an upper arm tourniquet
• The use of magnifying optics such as loupes is recommended
• A hand instrument set is used, possibly micro-instruments for reconstruction of the radial artery or nerves

Postoperative Analgesia

• Follow the link here to PROSPECT (Procedures Specific Postoperative Pain Management).
• Follow the link here to the current guideline Treatment of acute perioperative and post-traumatic pain.
• Possibly apply cold packs as a local physical measure.

Medical Follow-up Treatment

• Regular wound inspection, elastic compression bandage (Caution: constriction!) for a few days
• Suture removal after 14 days
• Possibly recommend fatty ointment for scar care (special scar ointment not necessary)
• Release of load after 14 days

Thrombosis Prophylaxis

• not applicable

Mobilization

• immediate

Physical Therapy

• Active exercise treatment with possible physiotherapeutic support with full extension and fist closure of the fingers from the 1st postoperative day (prevents hand edema and finger stiffness).
• Specific hand therapeutic measures in advanced cases with movement restriction of the wrist

Dietary Progression

• not applicable

Bowel Regulation

• not applicable

Incapacity for Work:

• Generally 14-21 days depending on manual activity (maximum 6 weeks)