Ganglion Cyst Excision 25111

synonyms:

Ganglion Cyst Excision CPT

• 25111(excision of wrist ganglion, dorsal or volar),
• 25112(excision recurrent ganglion)

Ganglion Cyst Excision Indications

• Painful ganglion which has failed conservative management

Ganglion Cyst Excision Contraindications

Ganglion Cyst Excision Alternatives

Ganglion Cyst Excision Pre-op Planning

Ganglion Cyst Excision Technique

Ganglion Dorsal Ganglion Technique

• Ganglion case card.
• Supine, arm board, +/-antibiotics, turniquet, 3.5x loupe magnification
• Transvers incision along Langer’s lines
• Skin hooks for retraction, iris/tenotomy scissors
• Mobilze circumferentially, retract extensor tendons(usually 4^thcompartment)
• Identify pedicle, dissect to origin(usually scapholunate ligament)
• Excise portion of dorsal wrist capsule and small portion of scapholunate ligament with pedicle.
• Irrigate wound
• Sub-q closure, skin closure
• 5cc 5% bupivicaine for post-op pain
• Dorsal/palmar splint

Ganglion Volar Ganglion Technique

• 65% arise form radioscaphoid joint near scapholunate interval, 34% from scaphotrapezial joint, 1% trapeziometacarpal joint.
• Usually located radial to FCR tendon
• Dissection may involve the palm, carpal tunnel, even dorsum of wrist due to extent of cyst
• Protect palmar cutaneous branch of the median nerve and terminal branches of lateral antebrachial cutaneous nerve. 
• Follow ganglion down to its origin and excise with small portion of capsule.
• 30% chance of recurrence.

Ganglion Cyst Excision Complications

Ganglion Cyst Excision Follow-up care

• Post-op: volar splint
• 7-10 Days: wound check.  Place in cock-up wrist splint for 2 weeks followed by gradual
• 3 Weeks:
• 6 Weeks:
• 2 Months:
• 3 Months:
• 6 Months:
• 1Yr:

Ganglion Cyst Excision Outcomes

• @15% recurrence risk after dorsal ganglion excision
• @30% recurrence risk after volar ganglion excision

Ganglion Cyst Excision Review References

• Thornburg LE, JAAOS 1999;7:231