Mucous cyst of the distal interphalangeal joint: Treatment by simple excision or excision and rotation flap

Abstract

Thirty-five patients who had thirty-seven mucous cysts excised from the distal interphalangeal joints were reviewed not less than one year later. Seven out of 25 which had been treated by simple excision recurred, whereas only one out of twelve treated by excision and skin closure with a rotation flap recurred.

The Zitelli Bilobed Flap on Skin Coverage After Mucous Cyst Excision: A Retrospective Cohort of 33 Cases

“…1 The recurrence rate after cryosurgical destruction ranges from 13% to 40% 9,10 whereas surgical cyst excision without osteophyte excision has a recurrence rate from 9.5% to 28%. 5,24,25 Cyst excision with DIP osteophyte excision is associated with a recurrence rate from 0% to 3.5%. 1,7,26e31 Joint debridement without cyst excision has been reported to be associated with a recurrence rate of 0% and with residual nail deformity in 10% of cases, but patients must be educated after surgery to expect slow resolution of the cyst.…”

“…4 In addition, many authors believe that the risk of recurrence is also reduced by these flaps because they allow excision of mucous deposits invading the thin skin overlying the cyst. 1,5,7 For this reason, many authors advocate skin excision and the use of local flaps to cover the resulting defect. 2,6,12,13 Many flaps have been described to provide this skin coverage, including some bilobed flaps with different designs.…”

The rhomboid flap: a simple technique to cover the skin defect produced by excision of a mucous cyst of a digit

“…7 Treatment has ranged from total excision of the joint to multiple needling and expression of the contents. 8 It was not until the 1970s that communication of the cyst into the joint space was demonstrated, 9 establishing the need to trace the pedicle into the joint space combined with osteophytectomy with appropriate skin cover 10,11 in order to prevent recurrence. 12 Designing local flaps when the secondary defect is to be closed directly in an unforgiving area like a finger can tax even the skill of an experienced plastic surgeon.…”

Mucous Cysts

“…9 Dodge reported recurrence in 5 of 18 patients at mean 7.5-year follow-up after excision of the cyst as well as any proliferative synovium or protruding osteophytes but not routine osteophyte excision. One surgery was complicated by osteomyelitis, requiring arthrodesis of the DIP joint.…”