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# Ganglions Are Your Garden Weeds, Technique Review, & Evidence on Ganglion Recurrence
- URL: https://www.theplasticsfella.com/august-25th/
- Published: 2024-08-23T19:16:18.000Z
- Updated: 2024-08-23T19:44:24.000Z
- Description: Also: New podcast episode, the Sunday quiz, & ganglion cyst clinical case.
- Author: PlasticsFella
- Tags: thePlasticsPaper

#### In this week's edition

1. ****✍️** [****Letter from P'Fella**](https://www.theplasticsfella.com/august-25th/#a-letter-from-pfella)  
Ganglions are your garden weeds.
2. ****🤓** [****The Sunday Quiz**](https://www.theplasticsfella.com/august-25th/#the-sunday-quiz)  
How well do you know ganglion cysts?
3. ****🎙️** [****Behind the 'Fella**](https://www.theplasticsfella.com/august-25th/#behind-the-fella)  
Episode 05 released: All about skin grafts.
4. ****🩺** [****Technique Review**](https://www.theplasticsfella.com/august-25th/#technique-review)  
The double dart technique for ganglions.
5. 🎓 [****theFellow's Corner**](https://www.theplasticsfella.com/august-25th/#the-fellows-corner)  
This week's feature: Ganglion Cyst - Clinical Case.
6. 📖 [****What Does the Evidence Say?**](https://www.theplasticsfella.com/august-25th/#what-does-the-evidence-say)  
What is the actual recurrence of ganglion cysts?
7. ****🔥**[ **Articles of the Week**](https://www.theplasticsfella.com/august-25th/#articles-of-the-week)  
Ganglion cyst management: 3 articles with 1 sentence summaries.
8. 💕 [****Feedback**](https://www.theplasticsfella.com/august-25th/#feedback)  
Suggest ideas & give feedback!

## A Letter from P'Fella

**Ganglions Are Your Garden Weeds*

👋

****Hey everyone!**  
  
  
Ganglions are like those stubborn weeds in the garden — annoying for both the gardener and the onlooker. They pop up without warning, disrupt the view, and no matter how often we deal with them, they seem to return. For us surgeons, ganglions are the garden's dandelions, sprouting up just when we thought we had cleared them out.  
  
Here’s why 👇

Managing ganglions feels like a never-ending battle against weeds. We can try aspiration, excision, or simply watch and wait. Yet, much like weeds, ganglions have a way of reappearing, sometimes in the same spot, sometimes elsewhere. Our approaches vary as widely as opinions on weed control — some dig deep with excision, others opt for the less invasive route of aspiration, and some prefer to leave them alone, knowing they can be messy and unpredictable.  

![](https://lh7-rt.googleusercontent.com/docsz/AD_4nXebIF-xD1LvxHeyJwHYiOSmP-L8Pj0EKYNujK9ep5pkmAvln0PgM_mzGkFgYSYiUyUlP4w9xlKbiohzxBUTT2urmC_jYIEEuZ1oYbhEtkaDTOfNOxS_FRW29lfWgfvU0npGXXpt5XJH_zxqhfFqZgaCdLmd?key=VE6BXUZFwhQudikkPVwgwA)

For patients, ganglions are just as frustrating. They bring discomfort and confusion, especially when different doctors give different advice. One may say, “Leave it alone,” while another suggests, “Let’s remove it.” This inconsistency can make patients feel lost in a garden of conflicting opinions.

Ganglions, like weeds, are a reminder of the inherent uncertainty in our practice. They show us that not every problem has a straightforward solution

So, the next time a ganglion pops up, think of it as a part of the garden's natural state. It's not about eradicating every weed but about managing the garden in a way that keeps the patient satisfied with their care. 

Lot of Love,   
P'Fella ❤️

## The Sunday Quiz

**How Well Do You Know* ***Ganglion Cysts** *?*

****Are you ready to make it to the leaderboard?**  
  
Welcome to ****the next round** of The Weekly Quiz.  
  
Each edition of thePlasticsPaper includes a quiz question designed to challenge and engage our readers. Keep your wits about you and join in every week — the winner at the end of six rounds will earn you a $100 voucher. 

![Definition of Ganglion Cysts](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2024/08/image-6.png)

Definition of Ganglion Cysts

## Behind the ‘Fella

**Sneak Peek from Episode 05*

🎧

****Tune in Now: "Behind the Fella"**  
  
Tune into our podcast for exclusive ****team meetings** where we uncover ****behind-the-scenes** details of the platform and discuss ****hot topics** in ****plastic surgery** with our fellows.   
  
Check out the latest episode where we discuss our experiences in skin grafting!  
  
You can subscribe on [Spotify](https://open.spotify.com/show/46pGp957C6aXCUKSqe03qR?ref=theplasticsfella.com) & [Apple](https://podcasts.apple.com/ie/podcast/behind-the-fella/id1746377600?ref=theplasticsfella.com). 

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## Technique Review

**The Double Dart Technique for Ganglions*

😷

****Technique Review**  
  
In this new section, we explore approaches or techniques in surgery. This edition looks at the double dart technique in managing ganglion cysts.   
  
👇

In 2010, [Paramhans](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890133/?ref=theplasticsfella.com) introduced the double dart technique: using concurrent 16-gauge (for aspiration) and 24-gauge needles (for triamcinolone acetonide injection) in the ganglion. This is visualised below. 

![Visualised the double dart technique in managing ganglion cysts. ](https://lh7-rt.googleusercontent.com/docsz/AD_4nXdBSKV6kZAYkbPujNbXRLevirpn4ueRc4ysX4HPSML91IVp10ToVWopS1bjUpHg9f7b9GRh5c3U5TJIZ75QS7AwGmt6TBXbS2WOhYZ9wcrYp2hU31MPcVC5l-FyiSG8cv8MP09chalUQsqRuwmdh9P45YO_?key=VE6BXUZFwhQudikkPVwgwA)

Double dart technique in managing ganglion cysts

Let us know your approach for treatment 👇

## the Fellows' Corner

**This Week's Focus:* ***Ganglion Cyst - Clinical Case**

In case you've missed out, here's a reminder to check out our fresh **articles**, clinical **cases**, and surgical **techniques**. 

Read below for an overview of our clinical case on **Ganglion Cysts**.

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2024/08/Clinical-Case-Ganglion-Cyst-1-1.png) 

#### Ganglion Cyst - Clinical Scenario

****Objectives**

1. Clinical diagnosis of a ganglion.
2. Describe the anatomical origins of ganglions.
3. Be aware of different aetiological theories.
4. Provide justified investigations to the patient.
5. Joint decision-making process for treatment options.

[Read the Article](https://www.theplasticsfella.com/ganglion-cysts-clinical-case/) 

## What Does the Evidence Say?

**What Is the Actual Recurrence of Ganglion Cysts?*

In this section, we dive deep into the latest research and evidence on medical practices and surgical techniques. 

Ganglion cysts are common ****soft tissue masses** of the hand and wrist, with recurrence rates varying widely after surgical excision.   
  
Studies report recurrence rates ranging from ****3.8%** to ****40%** (Graham et al., 2021; Cluts & Fowler, 2020). Risk factors for recurrence include male sex, surgeon inexperience, older age in pediatric patients, symptomatic masses, and previous aspiration (Cluts & Fowler, 2020; Mooney et al., 2020; Meyerson et al., 2019).   
  
Open ****surgical** ****excision** appears to have a lower recurrence rate compared to arthroscopic excision (Konigsberg et al., 2021). ****Ultrasound-guided** aspiration does not significantly reduce recurrence rates compared to ****blind aspiration** (Kurkis et al., 2018). For ****intraneural ganglion cysts**, addressing the joint connection is crucial to prevent recurrence (Desy et al., 2015; Yunga Tigre et al., 2023).   
  
Despite the risk of recurrence, patient satisfaction remains high after ganglion cyst excision, with most patients willing to undergo repeat surgery if necessary (Graham et al., 2021).

## Articles of the Week

**3 Interesting Articles with 1 Sentence Summaries*

✅

****Double Dart Technique for Treating Ganglions Over the Wrist** ([Paramhans](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890133/?ref=theplasticsfella.com), 2010)  
  
Explore the "double dart" technique of triamcinolone instillation; A non-invasive method to treat wrist ganglia with minimal side effects and a significantly lower recurrence rate than surgical excision.

✅

***Surgical Management of Ganglion Cysts: Complete Excision** ([Minotti](https://www.jhandsurg.org/article/S1531-0914%2802%2950015-2/abstract?ref=theplasticsfella.com), 2002)  
  
Discuss the management of ganglion cysts through complete cyst and pedicle excision, guided by the regional anatomy to minimize recurrence rates.

✅

****Untreated Dorsal Wrist Ganglia Outcomes vs Surgical Treatment** ([Dias](https://pubmed.ncbi.nlm.nih.gov/17950209/?ref=theplasticsfella.com), 2007)  
  
Explore untreated dorsal wrist ganglia in comparison to excision and aspiration outcomes; surgical excision results in higher patient satisfaction despite recurrence and complications.

## Feedback

### I hope you enjoyed it 😄

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