FAQ: Ganglion Cyst

This surgery attempts to remove the cyst intact which includes the fluid and the sac containing the fluid.

Risk include normal surgical risk such as wound infection and damage to surrounding tissue, which include the nerves and tendons that may run close to the cyst. Other possible risk includes joint infection and possible recurrence

A complete list of possible risks and complications and their explanation can be found at:https://www.drcolinhong.com/learn/risks-and-complications/ganglion-cyst/

If you are not experiencing any problems from the cyst, you may choose to not receive any treatments and with small cyst, it can go away on it's own. However, typical non-surgical management involves aspirating/expressing the fluid using a large size needle to open up the sac. (Please seek professional management as using non-sterile needles can causing infections to nearby joints and may cause injury to other areas the hand).

Removal of the cyst is not urgent and you can choose when it is convenient if you chose to have the cyst surgically removed.

The outcome of not intervening on these cysts can vary. Sometimes cyst may become larger, it may decrease in size and disappear and/or it can remain the same over long periods of time.

This is usually a minor surgery where an incision approximately the size of the cyst is made to remove the cyst intact. However, depending on the size and location of the cyst, sometimes surgical excision can be more extensive.

The range of reoccurrence is from 12-41% but this depends on the patient’s genetic predisposition as well as frequency of use.

Recovery time varies according to the size and location of the cyst. If the cyst is small, and superficial, it usually requires about 10-14 days for the incision to be completely healed and should not significantly affect the function of the hand/wrist (where it is most commonly located). However, if the cyst is more extensive in size or is located in areas that has caused significant distortion to the anatomy and function of the hand, it may require a more extensive recovery process, including some physical therapy for strength and stretching exercises.

The size of the scar will be approximately the size of the cyst. Over a 3-6-month duration, the incisional scar will fade in colour.

The size of the scar will be approximately the size of the cyst. Over a 3-6-month duration, the incisional scar will fade in colour.

Surgery usually takes about 20 minutes total. After consent is signed, an injection is made into the local area where the incision is made. After 10-15 minutes, when the anesthesia is in full effect, surgery is usually completed within 5-10 minutes.

There should be minimal pain after surgery. You may experience some soreness or bruise like sensation over the incisional site.

If you experience and post-operative pain, you should take some over the counter pain medications such as acetaminophen (Tylenol) or Ibuprofen (Advil/Motrin).

Typically there is no packing or tubing in the surgical site. You should expect the surgical site to be dressed with some superficial dressing.

Depending on the size and location of the cyst, you may or may not need any physical therapy. If you need any physical therapy session, you will be notified at the completion of your surgery and we will help set that up for you.

It requires 10-14 days for the incision to be completely healed. During that time, there is no restrictions to activities exception for intense sports that may cause the sutures to open up. Prompt usage of the hand is actually encourage and will help with the recovery process.

You can drive immediately after surgery.

You can return to work the next day.

Local anesthesia is used for this procedure.

Since only local anesthesia is used, it is not required that you see an anesthesiologist

Your medication list will be reviewed prior to surgery. However, you should also review your medication with your family doctor as well.

Generally, blood thinners should be stopped prior to surgery. However, different types of blood thinners should be stopped for different durations prior to surgery. Your family physician should be consulted as to when and if you should stop your medication prior to surgery.

Typically no other tests is required prior to surgery. However, certain individuals on specific types of blood thinners may need a blood test immediately prior to surgery.

There are no diet and fluid restrictions prior to or after surgery.

You should arrive at your appointment time for surgery.

Please call the office at (416)222-6986 to see your scheduled date and time for your surgery. This surgery is usually performed at two different hospital sites: Mackenzie Health Center or Rouge Valley Centenary Hospital. Once your appointment is set, you will be directed to the correct site.

If comfortable, you should be able to drive after surgery.

• Arrange for someone to take care of responsibilities at home and work
• Call your doctor if you think of other questions
• Notify your doctor if you get sick within 10 days of your surgery (even minor illnesses like a cold)
• Do not smoke or drink alcohol 24 hours before your surgery
• Make sure you have the doctor’s contact information
• Make sure you have directions to the hospital/office for visitors

• Surgery usually takes about 20 minutes total. After consent is signed, an injection is made into the local area where the incision is made. After 10-15 minutes, when the anesthesia is in full effect, surgery is usually completed within 5-10 minutes.

• You are typically awake for the whole procedure.

• Since this procedure is performed sterilely, no antibiotics is needed for this surgery.

• Make sure your identity has been confirmed with name and date of birth
• Make sure your procedure has been confirmed
• Make sure the correct site of your surgery has been marked
• Make sure the correct side of your surgery has been marked
• Confirm any allergies and side-effects you might have
• Make sure you understand and have signed the informed consent forms
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• Unless your surgeon specifically says otherwise, your surgery went according to plan without complications.

• With the exception of blood thinners, most prescription drugs do not need to be stopped and can be continued throughout the day of the procedure. Blood thinners can be restarted after surgery.

• There is no restrictions to eating or drinking prior to or after surgery.

• If you experience and post-operative pain, you should take some over the counter pain medications such as acetaminophen (Tylenol) or Ibuprofen (Advil/Motrin).

• After 24-48hrs, you can remove all the dressing around your surgical site. You can wash your hand like normal, allowing soap and water to run over the incision site. Please do not rub the incision as the stitches can come apart. Polysporin can be applied to the surgical site. No bandages are needed to cover the area after 48hrs.

• If the ganglion cyst is at the wrist, you should rest your hand for 1 week prior to physical therapy and exercises. If the cyst was in the fingers/toes, you can use your affected hand/foot immediately after surgery.

• You should return for a follow up appointment approximately 10-14 days after surgery for suture removal.

• Sutures are removed 10-14 days after your surgery. We will set up a date for you to return to have that done.

• With the exception of intense sports, you can resume your normal activity after surgery. Please wear a removable splint to protect the surgery site if your ganglion cyst was located in the wrist area.

• There is no restrictions to sexual activity before/after surgery.

• You can return to work the following day after surgery. You can resume work while wearing the removable splint if the ganglion cyst was at the wrist.

• There is no restrictions to driving after surgery.

• Make sure your care providers wash their hands before and after your care
• Do not wait until your pain is severe before you ask for pain medication
• Sit on the edge of the bed for a few minutes before you stand up to prevent getting dizzy
• Do not get out of bed without help if you feel weak or dizzy
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• You have a fever higher than 100.4 degrees Fahrenheit
• You have shortness of breath or chest pain
• You notice increased redness, swelling, warmth, or pain around your surgical incision
• You notice that your incision is separating or you have infected discharge from your incision
• Your dressing is repeatedly soaked with blood
• You experience weakness, numbness/tingling, or a coolness in your affected hand or foot
• You have pain that your existing pain medications cannot control
• Take pain and other medications as prescribed
• Do not drive when you are on prescription pain medications
• Do not soak in a bath or go swimming for ten days after your surgery
• Keep your incision clean and dry
• Keep your affected hand or foot elevated to reduce swelling
• Avoid strenuous exercise and heavy lifting as long as your doctor advises
• Follow your doctor’s instructions on resuming normal daily activities
• Follow your doctor’s instructions on resuming sexual activity
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• A ganglion cyst is a benign fluid filled sack typically found in the hands/wrist area but has been seen over almost all joints of the body. This sack is typically filled synovial fluid which is a gel like fluid that is found in joint spaces.

• Typically, there are two ways to treat a cyst. If these sacs are managed earlier, the fluid in the sac isn’t too thick and can be aspirated from the sac using a large size needle. However, sometimes depending on location or the consistency of the fluid, you may need a surgical excision of the sac.

• Although these cysts are benign, sometimes if it is located at an area where is frequent contact with other surfaces causing irritation and discomfort. In the distant past, people have use large books, such as the bible, to forcibly burst these cysts. Giving ganglion cyst the nick name of “bible cyst”. Although this is one method of dealing with the cyst, it is not recommended as it can often cause injury to other areas and there are other tumours that can mimic ganglion cyst.

• • There are different factors that helps determine whether the cyst should be removed surgically or simply aspirated with a needle.

  The size of the cyst and location of the cyst may make it harder/easier to aspirate. For example, if the cyst is large and very superficial, it is accessible for aspiration

  The consistency of the fluid in the cyst. Sometimes the fluid can be thickened and make it hard to aspirate/express the fluid from the sac.

  There are higher rates or recurrence when the cyst is aspirated as the lining of the cyst is not remove when it is aspirated opposed to surgical excision which usually removes the cyst intact.

• • The most commonly accepted cause of ganglion cysts is the herniated hypothesis where it is thought that cysts arise from weakening of the joint capsule/tendon sheath based on the idea that these cysts are often found along joint spaces/tendinous sheaths and the fluid found in these cavities are often similar to fluid found in joint spaces.

  The size of the cyst and location of the cyst may make it harder/easier to aspirate. For example, if the cyst is large and very superficial, it is accessible for aspiration

  The consistency of the fluid in the cyst. Sometimes the fluid can be thickened and make it hard to aspirate/express the fluid from the sac.

  There are higher rates or recurrence when the cyst is aspirated as the lining of the cyst is not remove when it is aspirated opposed to surgical excision which usually removes the cyst intact.

• • If the ganglion cyst is at the wrist, you should rest your hand for 1 week before starting any physical therapy or activity. Please protect with wrist with a removable splint. You should avoid swimming or tub bathing until your incision is completely healed (10-14days) and sutures are removed from the incision site

  The size of the cyst and location of the cyst may make it harder/easier to aspirate. For example, if the cyst is large and very superficial, it is accessible for aspiration

  The consistency of the fluid in the cyst. Sometimes the fluid can be thickened and make it hard to aspirate/express the fluid from the sac.

  There are higher rates or recurrence when the cyst is aspirated as the lining of the cyst is not remove when it is aspirated opposed to surgical excision which usually removes the cyst intact.

Hair loss usually follow your genetic course unless it is altered by medicine (i.e. propecia) and / or surgery

I do both FUE and FUT technique.

With FUE and FUT, the transplantation is usually the same but the extraction methods are different.