The Zitelli Design for Bilobed Flap Applied on Skin Defects After Digital Mucous Cyst Excision. A Review of 9 Cases

Abstract

Mucous cysts do not always require treatment. Nevertheless, patients often ask for excision because of pain or esthetics. Flap coverage is usually a concomitant procedure, which improves the quality of the skin overlying the distal interphalangeal joint. We propose the Zimany bilobed flap in this indication, and particularly its newer geometric design developed by Zitelli. We report the use of this flap in 9 cysts. Wound healing was fast with a good outcome. This flap design is an easy, safe procedure, and the Zitelli geometric design is a clear improvement for the reproducibility and learning curve.

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

“…6,32 Cyst and skin excision with local flap coverage has reported to have a recurrence rate from 0% to 8%. 2,8,13,15,33 In our series, the recurrence rate was 1 in 33 patient (3.3%), similar to previously published data.…”

“…19e23 Surgical excision of DIP mucous cysts is necessary when the patient reports discomfort in daily activities, the cyst is causing a nail deformity, or the surrounding skin becomes fragile and thin, leading to pain and increasing the risk of joint infection. 2,12,13,24 Recurrence rates vary depending on the surgical procedure. Needle puncture has a recurrence rate up to 100%.…”

“…Skin excision was planned creating a circular defect; the flap was then designed according to Zitelli's modified technique. 2 The first lobe should have the diameter of the defect, with the second lobe being slightly smaller in width but half a diameter longer. This second lobe covers the defect created by the first lobe.…”

“…Zitelli 16 reported a modified geometric design that facilitates flap drawing and reproducibility. It was first reported as a treatment for mucous cyst in 9 patients, with good outcome by Jager et al 2 The purpose of this study was to investigate the time to healing, recurrence rate, and aesthetic results achieved in the treatment of DIP joint mucous cysts using the Zitelli modified bilobed flap.…”

“…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. 14,15 In 1918, Esser reported a selfclosing bilobed flap for nasal tip skin injuries, later modified and popularized by Zimany.…”