Excision of Volar wrist ganglion cyst – is it dangerous?

“Volar wrist ganglion cyst develops underneath radial artery, restricting the movements of creases of the thumb affecting the radial and median nerve. Extreme care is required during excision of the cyst otherwise it may cause nerve damage.”

Volar wrist ganglion cyst usually develops underneath the radial artery following trauma, typically on outstretched hand, producing a small tear on the joint capsule. This results in escape of the joint fluid and body forms a small shell around fluid forming the cyst. Volar cyst typically appears on the palm side of the wrist and it is second most common type of wrist ganglion.

Volar wrist ganglion feels like a bump below the creases of the thumb and if it is increases in size, eventually it compresses the ulnar or median nerve which troubles in sensation and movement. Excision of cyst is recommended, when there is unbearable pain, restriction of the activities and sensation of the hand is impaired.

Excision of the volar wrist ganglion is really challenging as it winds around the radial artery. The excision of the volar wrist ganglion happens under the local anaesthesia. The cyst is observed carefully and a longitudinal incision is made on the top of the cyst with great care not to puncture the entire cyst which may affect the radial artery. Litmus scissors are used to separate the skin over the cyst. Small vessels are electro cauterized. First of all dissection is done proximally to locate the radial artery.

The radial artery is to be tied with passive vessel loop, then the cyst is punctured and the fluid inside the cyst is taken out.

The volar ganglion cyst is completely dissected along with the stalk of the cyst on the wrist joint with 15 blades and then small window of joint capsule also excised. To remove the remnants of the cyst, wound needs to be washed thoroughly. Electro cauterization has to be performed to avoid haemostasis.

With the help of 50 deep boucle and monocle stitch in reticular fashion wound has be to be closed. Nylon sutures are helpful in the long term closure of the wound.

Excision of the volar cyst is more effective, if the stalk that connects to the joint capsule and bit of tissues around the capsules are removed completely. Excision of volar wrist ganglion cyst has greater risk of blood vessel and nerve damage.