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Zhang F, Jiang H, Li Q, Yang H, Mi J, Rui Y, Zhao G. Outcome evaluation of dye-assist arthroscopic inside-out ganglionectomy: a retrospective study of 29 patients. BMC Musculoskelet Disord 2024; 25:723. [PMID: 39244540 PMCID: PMC11380379 DOI: 10.1186/s12891-024-07797-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 08/19/2024] [Indexed: 09/09/2024] Open
Abstract
OBJECTIVE To evaluate the clinical outcomes of arthroscopic inside-out ganglionectomy of dominant dorsal wrist ganglion. METHODS Patients with dominant wrist ganglion cyst treated in our hospital from January 1, 2014 to June 31, 2023 was enrolled in this retrospective analysis. All patients underwent dye-assist arthroscopic inside-out ganglionectomy. After discharge, the patients were followed for a minimum of 6 months. The primary outcomes were to assess patient wrist function using the Patient-Rated Wrist Evaluation (PRWE) and Mayo Modified Wrist Score (MMWS). The secondary outcomes were visual analog score (VAS), wrist active range of motion (ROM), grip strength, recurrence rate and complication. RESULTS All ganglion were successfully resected after dye staining. Patients were followed for an average of 12.17 months. There were no significant changes between preoperative and postoperative wrist active ROM or grip strength, except for wrist flexion (which showed a slightly greater improvement after surgery, P = 0.049), there were notable improvements in VAS, MMWS, and PRWE postoperatively. Recurrence occurred in 3 patients. No major complications observed during the follow-up period. CONCLUSION Dye-assist arthroscopic inside-out ganglionectomy is safe and uncomplicated, worth of clinical promotion.
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Affiliation(s)
- Fei Zhang
- Department of Hand Surgery WuXi No.9, People's Hospital Affiliated to SooChow University, WuXi, China
| | - Hong Jiang
- Suzhou Medical College of SooChow University, Suzhou, China
| | - Qian Li
- Department of Hand Surgery WuXi No.9, People's Hospital Affiliated to SooChow University, WuXi, China
| | - Haoyu Yang
- Department of Hand Surgery WuXi No.9, People's Hospital Affiliated to SooChow University, WuXi, China
| | - Jingyi Mi
- Department of Sport Medicine WuXi No.9, People's Hospital Affiliated to SooChow University, WuXi, China
| | - Yongjun Rui
- Department of Orthopeadics Surgery WuXi No.9, People's Hospital Affiliated to SooChow University, WuXi, China.
| | - Gang Zhao
- Department of Hand Surgery WuXi No.9, People's Hospital Affiliated to SooChow University, WuXi, China.
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Zhou J, Al-Ani S, Jester A, Oestreich K, Baldrighi C, Ting JWC. Wrist Ganglion Cysts in Children: An Update and Review of the Literature. Hand (N Y) 2022; 17:1024-1030. [PMID: 33174451 PMCID: PMC9608283 DOI: 10.1177/1558944720966716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ganglion cysts are the most common soft tissue tumor of the hand and wrist, affecting pediatric and adult populations. Despite their frequency, there is no consensus within the literature regarding the best management of pediatric wrist ganglia, and there are few recent publications examining this topic. We provide an up-to-date literature review examining the current issues and controversies in the management of pediatric wrist ganglia.
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Affiliation(s)
- Jieyun Zhou
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Monash Health, Melbourne, VIC, Australia
| | - Sami Al-Ani
- Hands and Upper Limb Service, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - Andrea Jester
- Hands and Upper Limb Service, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - Kerstin Oestreich
- Hands and Upper Limb Service, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - Carla Baldrighi
- Hands and Upper Limb Service, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - Jeannette W. C. Ting
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Monash Health, Melbourne, VIC, Australia
- Hands and Upper Limb Service, Birmingham Women’s and Children’s Hospital, Birmingham, UK
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Krishnan P, Wolf JM. Pediatric Ganglions of the Hand and Wrist: A Review of Current Literature. J Hand Surg Am 2022; 47:554-560. [PMID: 35216864 DOI: 10.1016/j.jhsa.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/26/2021] [Indexed: 02/02/2023]
Abstract
The etiology, epidemiology, and treatment outcomes of ganglions in children have not been studied in depth. Most research has mainly focused on adults with this condition, with some research suggesting differing epidemiology and outcomes in the pediatric population. This review focuses on the existing literature on pediatric ganglions of the hand and wrist, highlighting 17 studies focused on prevalence and treatment outcomes. Within the pediatric population, epidemiology and outcomes differ depending on patient age. In children aged <10 years, cysts present on the volar aspect of the wrist and are generally amenable to observation, with spontaneous regression. For patients aged >10 years, ganglions resemble those in the adult population and present on the dorsal aspect of the wrist. Open surgical excision demonstrates a relatively low recurrence rate with minimal complications and is currently recommended for treatment.
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Affiliation(s)
- Pranav Krishnan
- Pritzker School Medicine, University of Chicago, Chicago, IL
| | - Jennifer Moriatis Wolf
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL.
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Tuchin VV, Genina EA, Tuchina ES, Svetlakova AV, Svenskaya YI. Optical clearing of tissues: Issues of antimicrobial phototherapy and drug delivery. Adv Drug Deliv Rev 2022; 180:114037. [PMID: 34752842 DOI: 10.1016/j.addr.2021.114037] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/23/2021] [Accepted: 10/28/2021] [Indexed: 02/08/2023]
Abstract
This review presents principles and novelties in the field of tissue optical clearing (TOC) technology, as well as application for optical monitoring of drug delivery and effective antimicrobial phototherapy. TOC is based on altering the optical properties of tissue through the introduction of immersion optical cleaning agents (OCA), which impregnate the tissue of interest. We also analyze various methods and kinetics of delivery of photodynamic agents, nanoantibiotics and their mixtures with OCAs into the tissue depth in the context of antimicrobial and antifungal phototherapy. In vitro and in vivo studies of antimicrobial phototherapies, such as photodynamic, photothermal plasmonic and photocatalytic, are summarized, and the prospects of a new TOC technology for effective killing of pathogens are discussed.
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He B, Nan G. Use of a radiopaque localizer grid and methylene blue staining as an aid to reduce radiation exposure. MINIM INVASIV THER 2020; 31:84-88. [PMID: 32491922 DOI: 10.1080/13645706.2020.1771374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Localization of small femur lesions for resection can be challenging and may be associated with the need for significant fluoroscopic imaging and tissue dissection. This study was performed to evaluate the use of a radiopaque localizer grid along with methylene blue staining for resection of small femur lesions in children, and to determine the effectiveness of this effectiveness at reducing radiation exposure and tissue injury.Material and methods: A radiopaque localizer grid was used to identify the body surface site of bone lesions, and then 0.02-0.03 mL of methylene blue was injected into the bone lesions. After skin incision, the blue bone tissue was found and complete lesion resection performed.Results: A radiopaque localizer grid was utilized to plan the point of entry for lesion resection. The average operation time was shorter, and the C-arm was used less frequently, and the incision length was shorter in the grid and methylene blue group compared with the control group.Conclusion: A radiopaque localizer grid is a simple and practical device for efficient localization of the skin entry site, and methylene blue accurately pinpoints bone lesions, reducing radiation exposure and tissue injury.
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Affiliation(s)
- Bo He
- Department II of Orthopaedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, the Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Guoxin Nan
- Department II of Orthopaedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, the Children's Hospital of Chongqing Medical University, Chongqing, China
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Abstract
Background: Ganglion cysts are the most common type of soft tissue tumors of the hand. In the pediatric population, monitoring may be appropriate unless cysts are painful, interfering with range of motion or parental concerns exist. Reported recurrence rates after surgical removal of pediatric ganglion cysts vary widely in the literature. Notably, recurrence rates are higher for children than adults, ranging from as low as 6% to as high as 35%. Methods: A retrospective review was performed of a single pediatric hand surgeon's patients undergoing excision of primary and recurrent ganglion cysts from 2010 to 2015. Variables measured included patient age at diagnosis of ganglion cyst, time to presentation, location of cyst, hand dominance, previous therapy, previous surgery, length of surgery, tourniquet time, length of follow-up, any associated complications, and recurrence of cyst. Results: Ninety-six patients were identified with an average age of diagnosis 10.2 years. Indications for surgery: 95.8% for pain or decreased range of motion, 4.2% for cosmetic or parental concern. About 75% of the cysts were dorsally located, with the remaining 24.2% being volar. A total of 5 (5.3%) recurrences were recorded. Tourniquet time was on average 9.8 minutes longer for cases that resulted in recurrence. Multivariate analysis of the data demonstrated a 25% increased risk of recurrence with patients who had a previous aspiration. Conclusions: This is a retrospective review of a single pediatric hand surgeon's outcomes of pediatric wrist ganglion cysts. Our recurrence rate of 5.3% is low for a pediatric population indicating potential merit in this surgeon's operative and postoperative techniques. We demonstrate significantly increased rates of recurrence when a cyst had been previously aspirated, possibly indicating scarring and disruption of planes resulting in difficult dissection, increased tourniquet times, and incomplete excision.
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Affiliation(s)
- Joseph Meyerson
- The Ohio State University Wexner Medical Center, Columbus, USA,Nationwide Children’s Hospital, Columbus, OH, USA,Joseph Meyerson, Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Suite 2100, Columbus, OH 43212, USA.
| | - Yangshu L. Pan
- The Ohio State University Wexner Medical Center, Columbus, USA
| | - Maya Spaeth
- Nationwide Children’s Hospital, Columbus, OH, USA
| | - Gregory Pearson
- The Ohio State University Wexner Medical Center, Columbus, USA,Nationwide Children’s Hospital, Columbus, OH, USA
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Fernandes CH, Meirelles LM, Raduan Neto J, Fernandes M, dos Santos JBG, Faloppa F. Arthroscopic Resection of Dorsal Wrist Ganglion: Results and Rate of Recurrence Over a Minimum Follow-up of 4 Years. Hand (N Y) 2019; 14:236-241. [PMID: 29185350 PMCID: PMC6436138 DOI: 10.1177/1558944717743601] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dorsal wrist ganglia are the most common soft tissue tumor type of the upper limb. Surgical resection, open or arthroscopic, is one of the most frequent procedures performed by hand surgeons. This study sought to perform an objective evaluation of the outcomes of arthroscopic resection of dorsal wrist ganglia and their recurrence rates over 4 years. Patients treated with arthroscopic resection were expected to have favorable outcomes and low complication rates after 4 years of follow-up. METHODS We evaluated 34 cases of dorsal wrist ganglia in patients who underwent arthroscopic resection. The patients were evaluated using the Quick-Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measure, visual analog scale (VAS) for pain, range of motion of the wrist, palmar grip strength, rates of recurrence, and complications. RESULTS During the postoperative period, the QuickDASH score averaged 2.3 points, the mean residual pain by VAS was 0.54, full range of wrist movement was recovered by all patients, and the mean palmar grip strength was 29.4 kgf; there was 1 case with recurrence. There were no severe postoperative complications throughout the follow-up period. CONCLUSIONS The outcomes, recurrence, and complications rates after 4 years of follow-up presented in this study support the use of arthroscopy as a treatment for dorsal wrist ganglion.
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Affiliation(s)
- Carlos H. Fernandes
- Universidade Federal de São Paulo, Brazil,Carlos H. Fernandes, Hand Surgery Unit, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Borges Lagoa 786, São Paulo, São Paulo 04038-032, Brazil.
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Takahisa O, Yasuhiro S, Shinichi S. Arthroscopic ganglionectomy of a toe with color-aided visualization of the ganglion stalk. Foot (Edinb) 2017; 31:40-43. [PMID: 28544913 DOI: 10.1016/j.foot.2017.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/11/2016] [Accepted: 02/16/2017] [Indexed: 02/04/2023]
Affiliation(s)
- Ogawa Takahisa
- Suwa Central Hospital, Department of Orthopedics, 4300 Tamagawa, Chino-City, Nagano 391-8503, Japan.
| | - Seki Yasuhiro
- Suwa Central Hospital, Department of Orthopedics, 4300 Tamagawa, Chino-City, Nagano 391-8503, Japan
| | - Shirasawa Shinichi
- Suwa Central Hospital, Department of Orthopedics, 4300 Tamagawa, Chino-City, Nagano 391-8503, Japan
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Gray J, Zuhlke T, Eizember S, Srinivasan R. Dry Arthroscopic Excision of Dorsal Wrist Ganglion. Arthrosc Tech 2017; 6:e207-e211. [PMID: 28409102 PMCID: PMC5382237 DOI: 10.1016/j.eats.2016.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 09/10/2016] [Indexed: 02/03/2023] Open
Abstract
Ganglions are common soft tissue masses of the hand. High recurrence rates are associated with nonsurgical treatment; thus, excision is often indicated. Arthroscopic excision and open excision have similar recurrence rates; however, the latter is associated with prolonged healing time and increased scarring. Recently, dry wrist arthroscopic techniques have been used. This technique allows easier confirmation of complete ganglion removal, easier conversion to open surgery, earlier return of motion, and stitch-less closure when compared with traditional "wet" arthroscopic excision.
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Affiliation(s)
- Jason Gray
- Department of Orthopaedics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A
| | - Todd Zuhlke
- The Hand Center of San Antonio, San Antonio, Texas, U.S.A
| | - Shane Eizember
- Department of Orthopaedics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A.,Address correspondence to Shane Eizember, M.D., The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, U.S.A.The University of Texas Health Science Center at San Antonio7703 Floyd Curl DriveSan AntonioTX78229U.S.A.
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Su Y, Nan G. Using methylene blue as a marker to find and remove tiny metallic foreign bodies embedded in the soft tissues of children: A randomised controlled trial. Int J Surg 2016; 29:43-8. [PMID: 26975428 DOI: 10.1016/j.ijsu.2016.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/27/2016] [Accepted: 03/06/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Embedment of metallic foreign bodies in the soft tissues is commonly encountered in the emergency room. Most foreign bodies are easily removed, but removal is difficult if the foreign body is very small or deeply embedded. OBJECTIVE To determine the usefulness of methylene blue staining in the surgical removal of tiny metallic foreign bodies embedded in the soft tissue. METHODS This prospective study involved 41 children treated between May 2007 and May 2012. The patients were randomly divided into a methylene blue group and a control group. In the control group, foreign bodies were located using a C-arm and removed via direct incision. In the methylene blue group, foreign bodies were located using a C-arm, marked with an injection of methylene blue and then removed surgically. The clinical outcomes, complications, operation time, surgical success rate, incision length, frequency of C-arm use, and length and depth of the foreign body were compared between the two groups. RESULTS The surgical success rate was significantly higher in the methylene blue group. The average operation time was significantly shorter in the methylene blue group. The C-arm was used significantly less frequently in the methylene blue group than in the control group. The incision length was significantly shorter in the methylene blue group than in the control group. CONCLUSIONS Methylene blue staining facilitated the location and removal of tiny metallic foreign bodies from the soft tissue, and significantly reduced operation time, incision length and radiation exposure compared to the conventional method.
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Affiliation(s)
- Yuxi Su
- Department II of Orthopaedics, China International Science and Technology Cooperation base of Child development and Critical Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 40014, China.
| | - Guoxin Nan
- Department II of Orthopaedics, China International Science and Technology Cooperation base of Child development and Critical Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 40014, China.
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