Surgical Excision of the Ganglion
The definitive treatment for a ganglion mass is surgical excision. The surgical excision of a ganglion can be preformed under a local anesthesia, intravenous anesthesia or a general anesthesia. It is generally preformed in an outpatient surgery center. Under some circumstances the procedure may be preformed 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.
The recovery period depends upon the location of the ganglion and the amount of dissection required in 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 scarring in the area or recurrence of the mass. The patient is seen for their first follow up visit in 3 – 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 – 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.
Overall the surgical procedure is a 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 that the patient stay off the foot and keep 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 scarring. 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 and is not a need for concern. If excessive swelling or scarring occurs in the surgical site one of the small skin nerves may become caught in the scar tissue and result in pain following the surgery.