Comparative study between aspiration followed by Intralesional triamcinolone Injection, mixture of triamcinolone and hyaluronidase and surgical excision for the treatment of forearm ganglion in a medical college hospital

Abstract

Background: Ganglionic cysts are benign tumors of forearm commonly encountered in our day-to-day outdoor practice. This study compares the efficacy, safety, and recurrence rates of triamcinolone, a triamcinolone hyaluronidase mixture, and surgical excision for the treatment of forearm ganglion in a medical college hospital. Materials and Methods: This prospective comparative study was carried out at the SKIMS, Medical College, Hospital, over a period of 3 years. Between January 2018 and January 2021, 96 subjects with forearm ganglion were included and treated in three groups – Group A included patients who had aspiration and injection of triamcinolone; Group B patients had aspiration and injection of mixture of triamcinolone and hyaluronidase; and Group C patients underwent excision under anesthesia. The data were collected and analyzed using SPSS software 22. Results: Among 96 patients who met the inclusion criteria, the mean age was 35.74 years, with a male: female ratio of 0.63. The swelling was the most common clinical presentation recorded in 100% of patients. Swelling with symptoms such as pain and paresthesia was present in 59.38% of the patients, dissatisfaction with cosmetic appearance in 55.21% of the patients, and 36.46% subjects had apprehension of sinister lesion (malignant tumor). 47.92% of patients had aspiration and injection of triamcinolone (Group A), 43.75% of patients had aspiration and injection of triamcinolone-hyaluronidase mixture (Group B), and 8.33% of patients underwent surgical excision (Group C). The difference in recurrence rate was significantly lower in the Group B patients (15.22%) than in the Group A patients (2.38%) (P ≤ 0.05). We observed 100% success rate after surgical excision. No major postprocedure complications occurred in any of the patients. Conclusion: Aspiration and intracystic instillation of a triamcinolone-hyaluronidase mixture is a simple, effective, and safe treatment for ganglion with low recurrence rates. Following an unsuccessful primary therapy of aspiration and injection, surgical excision yielded excellent results.

Keywords

• ganglion
• hyaluronidase
• recurrence
• surgical excision
• triamcinolone