Hygroma is a cyst with dense walls filled with fluid. The tumor is always located in the joint area, since the walls of the tumor are the synovial membrane of the joint. Visually, the cyst looks like a tumor-like formation, but does not carry an oncological danger.
However, hygroma leads to other complications: the tumor impairs the function of the joint, provokes chronic inflammation, interferes with the proper functioning of the tendons, limits the motor activity of the hand and is an aesthetic defect. Of course, every patient will not experience all of the above-described adverse effects - depending on the location of the hygroma, it causes certain inconveniences.
If in your case a hygroma was diagnosed, which does not interfere with everyday life, this does not mean that it does not need to be treated. It is better to eliminate the pathology at an early stage of development, when the tumor is small and can be easily removed. However, the disease has various causes and treatment of wrist hygroma should include the elimination of the provoking factor, which determines the long-term result of therapy.
Features of the operation
Excision of the hygroma is an effective way to remove the cyst. You can try to cope with it with the help of a puncture or physiotherapeutic treatment, but no specialist can guarantee a 100% recovery.
Many patients are interested in whether it is possible to remove a hygroma without health consequences. You need to understand that any operation involves a risk of complications, but they will be minimal if the patient undergoes thorough preparation and the procedure itself is performed by a professional. Therefore, it is necessary to select a medical institution where the hygroma can be removed with special care. Doctors must have the necessary qualifications and have permission to perform such operations.
Preparation
Before the patient undergoes surgery, he must undergo a series of examinations, which include:
- Palpation of the hygroma by a surgeon.
The doctor determines the size and condition of the tumor, evaluates its structure, etc.
- Ultrasound.
This study is mandatory before surgery. During its implementation, it is possible to accurately determine the size, shape and structure of the tumor, as well as its location in relation to other tissues and structures (nerve fibers, joints, tendons, blood vessels).
- MRI
prescribed if the doctor has doubts about the nature of the tumor, or if it is located in hard-to-reach places.
- Hygroma puncture.
The procedure involves collecting the tumor contents, which are sent for histological analysis. Puncture allows us to exclude the presence of malignant cells in the tumor.
General preparation for surgery boils down to taking a blood test for biochemistry and assessing the coagulation system. Blood is also donated for HIV, hepatitis and syphilis.
Symptoms and diagnosis
When a tumor just begins to develop in the joint area, it may be subtle and not cause much discomfort. However, over time, the cyst increases in size, causing severe pain when bending and straightening the joints, making it impossible to lead a normal lifestyle. For example, with hygroma of the ankle, a person is actually unable to move normally. The tumor can increase even with slight physical exertion (in particular, after carrying bags of groceries), and then decrease again. In some cases, the formation of several hygromas at once is possible.
Characteristic signs of hygroma:
- a round seal, always located in the joint area;
- acute pain when pressed;
- increase in size and aching pain after physical activity;
- restriction in joint movement;
- mobile and elastic skin over the formation itself.
Diagnosis of hygroma is quite simple - in most cases, an examination by a professional doctor, palpation and ultrasound are sufficient. The specialist may also prescribe a biopsy to rule out other pathologies and malignancies.
How is the operation to remove hygroma performed?
Preparing for surgery is not difficult. However, hygromas are often located in close proximity to nerve endings, tendons and joints, so high skill is required from the surgeon.
In fact, a hygroma is a cyst that is located on the synovial bursa. Before deciding to have an intervention, a person should ask the doctor in detail about how the operation is going. The doctor must remove not only the tumor body itself, but its isthmus, after which the synovial bursa and wound edges are sutured.
The operation to remove a hygroma located on the wrist joint presents some difficulty. Many blood vessels and nerve endings are concentrated in this place. Their damage threatens to impair the function of the limb. Therefore, the procedure must be performed by a specialist practicing in the field of hand microsurgery. General surgeons are not always aware of all the nuances of how to remove a hygroma on the hand, so they do not undertake the operation.
Hygromas are most often located in the area of the wrist joint, although sometimes they are found on the feet. Athletes who significantly load their lower extremities are at risk. This operation has certain features, but its scheme has been worked out. Therefore, if the doctor is sufficiently qualified, then the risks of complications are minimal.
Types of hand surgeries
The following methods are used to eliminate:
- ruptures, injuries, other defects of the flexor and extensor tendons of the hand;
- pinched nerves;
- treatment of fractures of bones and joints of the hand and forearm;
- correction of improperly fused bones and soft tissues;
- removal of hygroma (ganglion) on the wrist;
- removal of foreign bodies of the hand;
- various diseases of bones, joints, soft tissues;
- elimination of tumors of any form.
If you have been scheduled for surgery, but you want to know more about its implementation or you have any other questions about hand surgery, you can ask them by calling +7 (905) 640-64-27 . Or contact me by sending a message from the Contact .
Stages of surgery to remove hygroma
After all preparatory measures have been completed, the doctor will tell the patient the date when surgical removal of the hygroma will be performed. Most often, the procedure is performed using local anesthesia. However, in severe cases, the person may be given general anesthesia. It is indicated when the hygroma is large, located in a hard-to-reach place and the operation will be extended over time.
The average procedure time is 30 minutes.
The main stages of how the operation is performed:
- The doctor makes an incision in the skin over the cyst.
- The doctor then carefully separates the tumor from surrounding tissue.
- It is important to find the place of attachment of the hygroma to the synovial bursa and dissect it. Sometimes surgeons remove the tumor along with its contents, and sometimes they first perform a puncture of the hygroma, pumping out the fluid inside.
- It is important to remove the tumor to the very base. If this is not done, then after a while it will fill with fluid again and repeated surgical intervention will be required.
- The final stage of the operation is suturing the tissues of the synovial bursa and the wound itself through which access to the hygroma was made.
A bandage is applied over the sutures. If necessary, the doctor additionally fixes the joint with a splint. The bandage will need to be changed every day. The stitches will be removed in 7-10 days. The splint is worn a little longer.
TREATMENT OF RECURRENT WRIST HYGROMAS.
¹Petkevich E.A., ¹Teplyakov A.N., ¹Starosvetskaya I.S., ²Voloshenyuk A.N.
¹State Institution “Republican Clinical Medical Center” of the Office of the President of the Republic of Belarus,
²Belarusian Medical Academy of Postgraduate Education,
Minsk
Despite numerous warnings about the dangers of a frivolous approach to surgical treatment of hygroma, relapses after surgical interventions occur in 20-25% of cases [1,2].
Purpose
This study was aimed at clarifying the reasons for unsatisfactory results after excision of hygroma of the carpal joint.
Materials and methods:
22 cases of relapse of carpal hygroma after surgical treatment were studied. Relapse occurred within 1 to 3 months after surgery. When interviewing patients, it was found that the intervention performed was characterized by the surgeon as “relatively simple”, “uncomplicated”; operations were performed on an outpatient basis, sometimes in a dressing room; local anesthesia was used. In none of the cases was exsanguination of the extremity used; immobilization was carried out in 2 cases and lasted no more than 10 days. It is also worth noting that in 5 cases a longitudinal incision was made over the hygroma, instead of the recommended and justified transverse one[3]. Most patients noted that the operation was performed “very quickly.”
Results:
14 patients were reoperated. The intervention was performed under conduction anesthesia or intravenous anesthesia. Bleeding was achieved by applying a pressure rubber bandage and a pneumatic cuff, fixed at the border of the lower and middle thirds of the shoulder, with a pressure created in it of 180-200 mm Hg. An incision was made along the old postoperative scar; if there was a longitudinal scar, its Z-plasty was performed. After excision of the hygroma, plastic surgery of the carpal joint capsule was performed. The limb was immobilized for 3 weeks, after which rehabilitation measures were carried out with gradually increasing intensity. Working ability was restored within 4-5 weeks after surgery, patients received recommendations to limit the load on the operated limb for up to six months, and in the future use elastic braces when performing physical work. The long-term results of repeated surgical interventions were studied for a period of at least 1 year - there were no relapses of hygroma.
Discussion:
To achieve a positive, lasting result in surgical treatment of wrist hygroma, we consider it necessary to strictly adhere to the following principles:
1. For adequate differentiation of anatomical structures - exsanguination of the limb, conduction or local anesthesia.
2. Adequate immobilization for the period of formation of the connective tissue scar, followed by gradually increasing load and the use of elastic clamps for up to six months.
Literature:
1. Ashkenazi A.I. “Surgery of the wrist joint”, M.: “Medicine”, 1990, 352 p.
2. Pichugov M.P., Pereladov A.A., Bykov V.V. Errors and complications in the treatment of hygroma. On Sat. “Materials of the III All-Russian Congress of Hand Surgeons”, Moscow, 2010, p.82
3. Zoltan J. Cicatrix optima. Budapest, 1983, 169 p.
Removal of hygroma with laser
Laser removal of hygroma is an innovative technique that minimizes the risk of complications. Instead of a scalpel, the surgeon uses a laser beam, which allows more precise control of the depth of the incision. During its implementation, the vessels are cauterized (coagulated), which prevents the development of bleeding. High temperatures help destroy bacterial flora, so the risk of tissue infection is minimal. However, the doctor must act carefully so as not to disrupt the integrity of the cyst and prevent its contents from entering the surrounding tissue.
There is another way to remove hygroma with a laser. In this case, the tumor is punctured with 2 needles. A laser LED is inserted into one puncture. With its help, the tumor is burned out from the inside. The doctor pumps out the liquid through the second needle. This intervention is less traumatic. After the operation, a pressure bandage is applied to the limb.
Removal of hygroma with a laser, as well as its excision with a scalpel, requires careful preparation of the patient for the operation.
The main advantages of using a laser include:
- The operation takes about 20 minutes.
- The procedure is practically bloodless, since the laser cauterizes all blood vessels.
- The scar after such tissue dissection is hardly noticeable and heals faster.
Full recovery occurs after a week. However, some experts are of the opinion that classical excision of a hygroma with a scalpel reduces the likelihood of its recurrence than when removing it with a laser. The fact is that in the latter case, suturing of the hilum of the hygroma is not carried out (the hilum is the place where the tumor connects to the joint).
How to prevent relapse
Prevention of recurrence of the disease must begin before surgery. High-quality removal of the tumor is possible only under general or regional anesthesia. Local puncturing around the lump will not allow the operation to be carried out in full. Thorough removal takes time.
Immediately after surgery, doctors apply a plaster cast or orthopedic brace to immobilize the joint. Such fixation must be maintained for 5 weeks, otherwise the risk of relapse will increase several times. Every day after the operation, dressings are made and the postoperative wound is treated. The stitches are removed after 10-12 days.
After removing the fixation device, the patient should gradually return to his usual lifestyle. In the first months, strength sports, carrying heavy objects, and intense physical work are prohibited. For a speedy recovery, doctors prescribe physiotherapeutic procedures, massage courses, and therapeutic exercises.
Timely removal of the tumor ensures complete recovery. To prevent relapses, you must strictly follow your doctor's recommendations.
Rehabilitation
Since the surgeon performs all manipulations in close proximity to the joints, the rehabilitation period should be scheduled in stages. Otherwise, the scar tissue will grow greatly, which can impair the mobility of the joint.
The sterile dressing that covers the stitch will need to be changed every day. The splint should securely fix the joint, but it should be positioned in such a way that it does not interfere with changing the bandage. The splint is worn for 21-30 days. The specific timing depends on the complexity and massiveness of the surgical intervention.
During the recovery period, it is necessary to minimize the load on the joint, but do not completely limit it. The doctor recommends the patient certain exercises that will allow him to develop the limb and quickly return it to its former functions.
Physiotherapy helps restore joints and tendons.
These include:
- Warming up.
- Electrophoresis.
- Magnetotherapy.
- Ultrasound therapy.
These methods are used both on their own and in combination.
Indications for surgery
Surgeries on the hand are prescribed in cases of injuries and orthopedic diseases that are not amenable to conservative treatment. Among them:
- Knott's disease;
- hygroma of the wrist;
- Dupuytren's contracture (palmar fibromatosis);
- tunnel syndrome;
- damage to tendons and ligaments;
- foreign bodies of the hand;
- joint dislocations;
- fractures of varying severity;
- false joints and improperly fused bones after fractures;
- as well as many other consequences of trauma.
In the presence of the listed ailments, hand surgery helps restore mobility, restore physiological functions, and also eliminate pain and discomfort.
If timely measures are not taken to eliminate injuries and deformations, they can cause pain and discomfort for many years. Therefore, the sooner you contact an orthopedic surgeon to correct your ailments, the better for you.