Muhammad Saaiq, Hameed-ud Din, Salman Zaib, Shehzad Ahmad, Mansur Ali.
Dorsal Wrist Ganglions: Is Aspiration and Triamcinolone Injection Superior to Surgical Excision?.
Ann Pak Inst Med Sci Jan ;8(2):93-5.

Objective: To compare the efficacy of resolution, frequency of complications and recurrence of managing dorsal wrist ganglions with aspiration followed by intra-cystic injection of triamcinolone acetonide versus surgical excision. Study Design: Randomized controlled trial. Place and Duration: This study was carried out in the Department of Plastic and Reconstructive Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad during the period from August 01, 2005 to August 31, 2011. Materials and Methods: All adult patients of either gender and all ages with clinical diagnosis of dorsal wrist ganglion were included. Patients with diabetes, malignancy, or bleeding diathesis were excluded. Half of patients were randomly assigned to the aspiration/ injection group and half to the surgical excision group. In the aspiration/ injection group, the ganglion was first aspirated and then 40mg triamcinolone acetonide was injected. In the surgical excision group, ganglion was excised under local anesthesia. The primary outcome measure was successful resolution of ganglion while the secondary outcome measures were complications and recurrence within two years. Results: Out of 60 patients, 78.33% (n=47) were females while 21.66% (n=13) were males. The mean age was 21.88±6.79 years. The duration of the ganglions was 15.28±4.85 months. Successful resolution of the ganglion was achieved in all the patients in both the groups following intervention. In triamcinolone group, mild pain was reported by 23.33%(n=7) patients while recurrence over two years was seen in two patients. (recurrence rate of 6.66%). In the surgical excision group, all the patients experienced moderate pain postoperatively which necessitated oral analgesics for five days, and restricted wrist mobility for 02 week. Recurrence over two years was seen in five patients. (recurrence rate of 16.66% ) Conclusion: Aspiration followed by intra-cystic injection of triamcinolone is superior to surgical excision in managing dorsal wrist ganglion. As the aspiration/ injection is associated with a lower recurrence rate and less post procedure morbidity, it should be employed as the first line treatment.

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