Perioperative management - Ganglionectomy for palmar wrist ganglion

• Pain
• Movement disorder

• Local or general conditions that surgically or anesthesiologically contraindicate an elective operation or are preoperatively improvable

• Clinical examination:
  → Inspection/Palpation of a painful thickening along the course of the radial artery at the flexor side of the wrist
• Ultrasound: Detection of a fluid-filled cavity with connection to the radiocarpal joint, scaphotrapezoid or radioscaphoid joint
• If necessary, MRI in case of unclear findings

• no special preparation of the patient necessary
• generally outpatient procedure
• Clarification of contraindication for bloodless field (e.g., existing shunt in dialysis)

Information about

• surgical method
• extension procedures such as e.g. reconstruction of A. radialis, nerve

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

• specific surgical risks
  • injury to R. superficialis N. radialis or N. cutaneus antebrachii lateralis with neuropathic pain
  • injury to A. radialis
  •  protracted scar pain (usually subsides after 6 months)
  •  persistent complaints
  • revision surgery
  • risk of recurrence 

• intravenous regional anesthesia
• plexus anesthesia
• general anesthesia

• Supine position
• Positioning of the hand on a hand table
• Recommended application of upper arm tourniquet

• The surgeon should sit on the side where the dominant hand with the scissor tip points distally
• If necessary, an assistant sits opposite
• The scrub nurse positions themselves at the head end of the hand table

• The application of an upper arm tourniquet is recommended
• The use of magnifying optics such as magnifying glasses is recommended
• A hand instrument set is used, possibly a microinstrument set 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 posttraumatic pain.
• If necessary, application of cold packs as a local physical measure.

Medical Aftercare 

• Regular wound inspection, elastic compressive bandage (Caution: Constriction!) for a few days
• Suture removal after 14 days
• If necessary, recommendation of greasy ointment for scar care (special scar ointment not necessary)
• Release for loading after 14 days

Thrombosis Prophylaxis

• not applicable

Mobilization

• immediately

Physiotherapy

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

Diet Build-up

• not applicable

Stool Regulation

• not applicable

Inability to Work: 

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