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Tonogai I, Yamasaki Y, Nishisho T, Sairyo K. Republication of "Mucous Cyst at the Interphalangeal Joint of the First Toe Caused by Contact Pressure With the Second Toe due to Hallux Valgus: A Case Report". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231192974. [PMID: 37566681 PMCID: PMC10408337 DOI: 10.1177/24730114231192974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Abstract
A 77-year-old woman presented with a mucous cyst on the lateral aspect of the interphalangeal joint of the first toe caused by contact pressure with the second toe from hallux valgus. She complained of discomfort and discharge from the left first toe for approximately 4 months. Physical examination showed the second toe pressing strongly against the first toe due to hallux valgus and discharge from the skin on the lateral aspect of the interphalangeal joint of the first toe. Magnetic resonance imaging showed a cystic lesion at the same level. The patient underwent a modified scarf osteotomy of the first metatarsal for hallux valgus to resolve the contact pressure between the toes-considered the cause of the mucous cyst-and resection of mucous cyst. Forefoot weight bearing was allowed 6 weeks after surgery. As of 1 year after surgery, she has had no recurrence of the cyst. The score on the Japanese Society for Surgery of the Foot hallux metatarsophalangeal-interphalangeal scale improved from 59/100 points to 92/100. This outcome suggests that hallux valgus correction should be considered when a mucous cyst is associated with contact pressure due to a hallux valgus deformity. To the best of our knowledge, there are no previous reports of a mucous cyst caused by contact pressure between the first toe and second toe due to hallux valgus.
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Affiliation(s)
- Ichiro Tonogai
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan
| | - Yuhei Yamasaki
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan
| | - Toshihiko Nishisho
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan
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Evaluation of the Demographic and Clinical Features of Patients With Digital Myxoid Pseudocysts and Their Response to Treatment. Dermatol Surg 2022; 48:625-630. [PMID: 35333205 DOI: 10.1097/dss.0000000000003433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Digital myxoid pseudocysts (DMPs) are the most common benign degenerative lesions of the nail unit. There is currently no consensus regarding first-line treatments for DMPs. OBJECTIVE To evaluate demographic and clinical features and treatment methods of DMP and examine recurrence rates and factors that may affect recurrence. METHODS AND MATERIALS All patients in the authors' clinic who were diagnosed with DMP between 2013 and 2020 were included. Treatment methods were categorized as surgical excision (SE), drainage and compression (DC), simple drainage (SD), and no treatment. Responses and recurrence rates after different treatment methods were investigated. RESULTS Fifty-one lesions from 48 patients were included. Thirty-two lesions were treated with SE, 11 with DC, and 1 with SD, while 7 lesions were left untreated. The initial complete response rate after SE was significantly higher than that after DC. No statistically significant difference was found between the recurrence rates of the 2 treatment methods. Using intra-articular methylene blue during SE did not seem to affect recurrence rates. CONCLUSION Drainage and compression seems to be a safe and effective first-line treatment option for DMPs located on the proximal nail fold and distal interphalangeal joint. SE is more favorable as a second-line treatment.
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Osteophyte-Sparing Treatment of Mucous Cysts: Case Analysis and Surgical Technique. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202111000-00003. [PMID: 34748522 PMCID: PMC8575422 DOI: 10.5435/jaaosglobal-d-21-00164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to examine patient outcomes and the risk of recurrence of mucous cysts affecting the distal interphalangeal (DIP) joint in the absence of osteophytectomy using the described flap technique.
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Digital Myxoid Cysts: Correlation of Initial and Long-Term Response to Steroid Injections. Dermatol Surg 2021; 47:e146-e152. [PMID: 33784449 DOI: 10.1097/dss.0000000000002944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Digital mucous cysts (DMCs) are benign myxoid pseudocysts that develop on the distal interphalangeal joint's lateral or dorsal aspects. Management consists either of a surgical approach, conservative therapy, or simple follow-up. OBJECTIVE To correlate the initial and long-term response with clinical and ultrasound parameters in DMCs treated with intralesional steroids as first-line therapy. METHODS A single-center prospective open-label study recruited 15 patients affected by DMCs, who had been treated with a cycle of up to 3 steroid injections at a 6 to 9 week time interval. RESULTS At the first follow-up visit, 53.3% of patients were cleared of DMCs, achieving a complete response, whereas 46.7% experienced a >30% decrease in their DMC volume, and were considered partial responders. After 1 year of follow-up, the cure rate decreased to 40%, and the recrudescence rate was 27.3%. Clinical and sonographic characteristics that positively correlated with a maintained complete response at follow-up were as follows: young age, absence of osteophytes, low volume, complete clearance at T1, and short disease duration (p < .05). CONCLUSION Intralesional steroid therapy is an easy approach for DMC, with minimal side effects; identifying predictive hallmarks is useful to offer a straightforward surgical treatment to patients who have nonresponder characteristics.
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Weinheimer K, Patrick N, Darowish M. Treatment of Distal Interphalangeal Ganglion Cysts by Volar Corticosteroid Injection. Hand (N Y) 2019; 14:381-385. [PMID: 29239251 PMCID: PMC6535951 DOI: 10.1177/1558944717744336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Various options exist for operative and nonoperative treatment of symptomatic distal interphalangeal (DIP) ganglion cysts. We describe the technique and efficacy of a novel treatment of DIP ganglion cysts using a volar, transtendon, intra-articular injection of corticosteroid. METHODS This was a single center, retrospective study (2010-2015) of 21 patients who received a volar, intra-articular corticosteroid injection for treatment of DIP ganglion cysts. The patients were contacted via mailing with a short survey. For those potential study participants who did not respond to the mailing or were not seen in follow-up, contact was made via telephone. The primary study outcome was resolution of the cyst; secondary outcomes included pain and postinjection complications. RESULTS A total of 21 patients (14 female; 7 male) with 23 DIP ganglion cysts were treated in this study. The dominant hand was involved in 56.5% cases. Twelve (52.2%) resolved or had near complete resolution following injection at an average follow-up of 20 months. CONCLUSIONS For patients with DIP ganglion cysts, this newly described technique of volar, transtendon, intra-articular injection of corticosteroid provides a safe and effective treatment. This technique allows for ease and consistency of needle placement for intra-articular corticosteroid delivery while minimizing the potential soft tissue and infection concerns described with other techniques.
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Affiliation(s)
- Kent Weinheimer
- Penn State Health Milton S. Hershey
Medical Center, Hershey, PA, USA
| | - Nathan Patrick
- Penn State Health Milton S. Hershey
Medical Center, Hershey, PA, USA
| | - Michael Darowish
- Penn State Health Milton S. Hershey
Medical Center, Hershey, PA, USA,Michael Darowish, Department of Orthopaedic
Surgery, Penn State Health Milton S. Hershey Medical Center, 30 Hope Drive, PO
Box 859, Hershey, PA 17033, USA.
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Balakirski G, Löser CR. [Mucous pseudocysts-when and how to treat?]. Hautarzt 2018; 69:712-717. [PMID: 30046862 DOI: 10.1007/s00105-018-4233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The treatment of mucous pseudocysts must consider their tendency for recurrence. There are numerous established treatment options available. The decision on the optimal therapy, however, depends on the clinical presentation and symptoms as well as on possible side effects. This review presents surgical as well as nonsurgical treatment options for digital mucous pseudocysts and an algorithm is suggested. For recurrent and symptomatic lesions with pain or deformation of the nail plate, surgical excision of the pseudocyst and closure with a flap can be considered.
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Affiliation(s)
- G Balakirski
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum der Rheinischen Friedrich-Wilhelms-Universität Bonn, Bonn, Deutschland
| | - C R Löser
- Hautklinik, Hauttumorzentrum, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen am Rhein, Deutschland.
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Tonogai I, Yamasaki Y, Nishisho T, Sairyo K. Mucous Cyst at the Interphalangeal Joint of the First Toe Caused by Contact Pressure With the Second Toe due to Hallux Valgus. FOOT & ANKLE ORTHOPAEDICS 2018. [DOI: 10.1177/2473011418775101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 77-year-old woman presented with a mucous cyst on the lateral aspect of the interphalangeal joint of the first toe caused by contact pressure with the second toe from hallux valgus. She complained of discomfort and discharge from the left first toe for approximately 4 months. Physical examination showed the second toe pressing strongly against the first toe due to hallux valgus and discharge from the skin on the lateral aspect of the interphalangeal joint of the first toe. Magnetic resonance imaging showed a cystic lesion at the same level. The patient underwent a modified scarf osteotomy of the first metatarsal for hallux valgus to resolve the contact pressure between the toes— considered the cause of the mucous cyst—and resection of mucous cyst. Forefoot weight bearing was allowed 6 weeks after surgery. As of 1 year after surgery, she has had no recurrence of the cyst. The score on the Japanese Society for Surgery of the Foot hallux metatarsophalangeal-interphalangeal scale improved from 59/100 points to 92/100. This outcome suggests that hallux valgus correction should be considered when a mucous cyst is associated with contact pressure due to a hallux valgus deformity. To the best of our knowledge, there are no previous reports of a mucous cyst caused by contact pressure between the first toe and second toe due to hallux valgus.
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Affiliation(s)
- Ichiro Tonogai
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan
| | - Yuhei Yamasaki
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan
| | - Toshihiko Nishisho
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan
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Myxoid Cyst as a Probable Complication of Nail Surgery. Dermatol Surg 2018; 44:1647-1649. [PMID: 29381549 DOI: 10.1097/dss.0000000000001481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jiménez I, Delgado PJ, Kaempf de Oliveira R. The Zitelli Bilobed Flap on Skin Coverage After Mucous Cyst Excision: A Retrospective Cohort of 33 Cases. J Hand Surg Am 2017; 42:506-510. [PMID: 28434834 DOI: 10.1016/j.jhsa.2017.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 02/12/2017] [Accepted: 03/08/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To study the time to wound healing and recurrence rate achieved in the treatment of distal interphalangeal joint mucous cysts using the Zitelli modified bilobed flap. METHODS We surgically treated 33 patients from January 2006 to June 2015. We assessed demographic data, comorbidities, location and size of the cyst, time to wound healing, and complications. RESULTS The most affected finger was the right middle finger. All flaps survived and wounds healed in 14 days on average. The mucous cyst recurred in 1 of 33 cases. There were no major complications. CONCLUSIONS The Zitelli bilobed flap can provide good-quality skin coverage over the distal interphalangeal joint in a short period. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Isidro Jiménez
- Hand and Upper Extremity Surgery Unit, Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, Spain
| | - Pedro J Delgado
- Hand and Upper Extremity Surgery Unit, Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, Spain.
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Balakirski G, Loeser C, Baron JM, Dippel E, Schmitt L. Effectiveness and Safety of Surgical Excision in the Treatment of Digital Mucoid Cysts. Dermatol Surg 2017; 43:928-933. [PMID: 28272086 DOI: 10.1097/dss.0000000000001096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Digital mucoid cysts have a tendency for recurrence after operative intervention. Several procedures are in use. OBJECTIVE Retrospective evaluation for effectiveness, safety and patient satisfaction by using a questionnaire after treatment for digital mucoid cysts with targeted surgical excision and closure by flap-design. MATERIALS AND METHODS All patients treated with surgical excision for digital mucoid cysts at the Dermatology Department of the Ludwigshafen City Hospital between 2007 and 2011 were evaluated using a specially designed questionnaire. RESULTS We evaluated 31 patients. The patient group consisted of 65% women, the median age was 61 years. Seventy-eight percent of patients with nail involvement had a marked improvement or complete resolution of this complaint after surgery. A few complications (e.g., redness, pain or hematoma) were observed after treatment, but no patients required oral antibiotics. Patient evaluation of cosmetic outcome revealed high satisfaction with the procedure, nevertheless recurrence of the digital mucoid cysts was observed in 22.5% of all cases. CONCLUSION Surgical excision in treatment of digital mucoid cysts was shown to be effective and safe. However, possible advantages and disadvantages of this treatment option should be discussed with the patients before a decision on the kind of therapy is reached.
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Affiliation(s)
- Galina Balakirski
- *Department of Dermatology and Allergology, University Hospital of RWTH Aachen, Aachen, Germany; †Department of Dermatology, Ludwigshafen City Hospital, Ludwigshafen, Germany
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Jabbour S, Kechichian E, Haber R, Tomb R, Nasr M. Management of digital mucous cysts: a systematic review and treatment algorithm. Int J Dermatol 2017; 56:701-708. [DOI: 10.1111/ijd.13583] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/11/2017] [Accepted: 01/11/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Samer Jabbour
- Department of Plastic and Reconstructive Surgery; Faculty of Medicine; Saint Joseph University; Hotel Dieu de France Hospital; Beirut Lebanon
| | - Elio Kechichian
- Department of Dermatology; Faculty of Medicine; Saint Joseph University; Hotel Dieu de France Hospital; Beirut Lebanon
| | - Roger Haber
- Department of Dermatology; Faculty of Medicine; Saint Joseph University; Hotel Dieu de France Hospital; Beirut Lebanon
| | - Roland Tomb
- Department of Dermatology; Faculty of Medicine; Saint Joseph University; Hotel Dieu de France Hospital; Beirut Lebanon
| | - Marwan Nasr
- Department of Plastic and Reconstructive Surgery; Faculty of Medicine; Saint Joseph University; Hotel Dieu de France Hospital; Beirut Lebanon
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Makaram N, Chaudhry IH, Srinivasan MS. Hidradenoma masquerading digital ganglion cyst: A rare phenomenon. Ann Med Surg (Lond) 2016; 10:22-6. [PMID: 27625783 PMCID: PMC5011080 DOI: 10.1016/j.amsu.2016.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/20/2016] [Accepted: 07/20/2016] [Indexed: 12/12/2022] Open
Abstract
Introduction Mucous cyst is the commonest soft tissue tumor in the dorsum of the distal interphalangeal joint (DIPJ) of the finger. We report the first case of a recurring eccrine tumor (nodular hidradenoma), mimicking a mucous/ganglion cyst, on the dorsum of the DIPJ. Case report A 54 year old man presented with painless, hemispherical, colored swelling on the dorsum of his right middle finger (dominant hand), which appeared to have recurred from a previous surgery. The lesion was excised and operative findings from the medical notes showed the gross appearance to be a soft, white, glistening, smooth-surfaced, myxoid nodule resembling a “ganglion cyst”. Immunohistochemistry showed the tumour to be positive for S100, smooth muscle actin and cytokeratin 7. Ductal differentiation was confirmed by staining for epithelial membrane antigen and carcinoembryonic antigen. The histological features were that of atypical and solid cystic hidradenoma. Discussion This is the first reported case of this rare tumour presenting as mucous cyst. We conduct a review of the literature of nodular hidradenomas, illustrating the immunohistologic findings in this tumour to emphasise the atypical features.We emphasise the importance of considering hidradenoma in the differential diagnosis of such lesions of the finger, in view of its high recurrence rate and the possibility of malignant transformation. We describe the rare phenomenon of an atypical cystic hidradenoma mimicking in presentation a mucous ganglion cyst on the DIPJ of the finger. We put this rarity into context by performing a literature review of reported presentations of such tumours. We emphasise the importance of a thorough and systematic assessment in patients presenting with such lesions. Also highlighted is the importance of considering these tumours in the differential diagnosis of lesions of the DIPJ. Thorough immunohistochemistry of resulting biopsies is invaluable in aiding diagnosis in these scenarios of ambiguous soft tissue swellings.
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Affiliation(s)
- Navnit Makaram
- Department of Surgery, Ninewells Hospital & Medical School, University of Dundee, Dundee, DD1 9SY, UK
- Corresponding author.
| | - Iskander H. Chaudhry
- St. James's University Hospital, 16 17 Beckett St., Leeds, West Yorkshire, LS9 7TF, UK
| | - Makaram S. Srinivasan
- Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK
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Roulet S, Marteau E, Bacle G, Laulan J. Surgical treatment of mucous cysts by subcutaneous excision and osteophyte resection: Results in 68 cases at a mean 6.63 years' follow-up. ACTA ACUST UNITED AC 2015; 34:197-200. [PMID: 26188999 DOI: 10.1016/j.main.2015.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/07/2015] [Accepted: 06/02/2015] [Indexed: 11/26/2022]
Abstract
The goal of this study was to assess the results of treatment of mucous cysts by subcutaneous excision and osteophyte resection without an associated skin procedure. From 1993 to 2013, 81 mucous cysts were operated on. In 27 cases, a nail deformity was present. Obvious osteoarthritis was present in 84% of cases. Among them, 67 patients (68 cysts) were subsequently assessed through a phone questionnaire after a mean follow-up of 6.6 years. Patients who reported a recurrence or suspected one were reassessed in consultation. Among the 68 evaluated cases, two developed an infection and one had delayed skin healing; these complications occurred on cysts with a previous fistula. In one case (1.5%), a recurrence was observed four months after excision of a subungual cyst. All nail deformities had resolved; 53 patients felt no discomfort and 65 were very satisfied or satisfied with the procedure and would undergo surgery again. The recurrence rate of 1.5% is consistent with that of other studies where the same procedure was used, without cutaneous grafting, ranging from 0 to 2%. This result is better than in studies where a graft or a flap was performed without systematic joint debridement. Our procedure is sufficient to effectively treat mucous cysts with less morbidity. Complications are rare and occur only in cysts associated with a fistula, justifying their early surgical treatment.
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Affiliation(s)
- S Roulet
- Unité de chirurgie de la main, services de chirurgie orthopédique et traumatologique 1 et 2, hôpital Trousseau, CHU de Tours, 37044 Tours cedex, France
| | - E Marteau
- Unité de chirurgie de la main, services de chirurgie orthopédique et traumatologique 1 et 2, hôpital Trousseau, CHU de Tours, 37044 Tours cedex, France
| | - G Bacle
- Unité de chirurgie de la main, services de chirurgie orthopédique et traumatologique 1 et 2, hôpital Trousseau, CHU de Tours, 37044 Tours cedex, France
| | - J Laulan
- Unité de chirurgie de la main, services de chirurgie orthopédique et traumatologique 1 et 2, hôpital Trousseau, CHU de Tours, 37044 Tours cedex, France.
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15
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Cogrel O. [Myxoid pseudocyst: when and how to treat?]. Presse Med 2014; 43:1260-6. [PMID: 25312852 DOI: 10.1016/j.lpm.2014.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 06/03/2014] [Indexed: 10/24/2022] Open
Abstract
Myxoid pseudocysts (MPCs) are the most frequent pseudotumors of the digit and dermatologists are frequently referred. It is now believed that MPCs occur as a result of a leakage of synovial fluid through a breach in the joint capsule of the distal interphalangeal joint promoted by osteoarthritis. Many treatments have been proposed from simple repeated punctures, injections of steroids or sclerosants, cryosurgery, laser evaporation, infrared coagulation to surgical excision. Surgical procedures depend on the location of MPCs in the nail apparatus. In this review, we will discuss the best approaches to the treatment of MPCs whereas no guidelines are available for their management.
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Affiliation(s)
- Olivier Cogrel
- CHU de Bordeaux, hôpital Haut-Lévêque, service de dermatologie, avenue de Magellan, 33604 Pessac, France.
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16
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Abstract
There is no clear consensus about the best operative technique for the treatment of digital mucous cysts. We carried out a retrospective review of all patients who underwent excision of a digital mucous cyst using a local advancement skin flap over a 10-year period. A total of 69 patients were included and were reviewed at an average of 38 months (minimum 6 months) post-operatively. No patients were lost to follow-up. There was only one case of cyst recurrence. Of these 67 patients were happy with the scar and 63 patients said they would have the procedure again; 36 patients had a pre-operative nail deformity and 21 reported that the deformity grew out after the procedure.
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Affiliation(s)
- S M Johnson
- Department of Orthopaedic Surgery, Raigmore Hospital, Inverness, UK
| | - K Treon
- Department of Orthopaedic Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - S Thomas
- Department of Orthopaedic Surgery, Perth Royal Infirmary, UK
| | - Q G N Cox
- Department of Orthopaedic Surgery, Raigmore Hospital, Inverness, UK
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Kanaya K, Wada T, Iba K, Yamashita T. Total dorsal capsulectomy for the treatment of mucous cysts. J Hand Surg Am 2014; 39:1063-7. [PMID: 24785701 DOI: 10.1016/j.jhsa.2014.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 03/03/2014] [Accepted: 03/03/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the technique of total dorsal capsulectomy alone for mucous cysts of the distal interphalangeal (DIP) joint and evaluate its outcomes and complications. METHODS Nineteen patients (18 women and 1 man) with 19 mucous cysts were treated by a total dorsal capsulectomy without cyst excision or osteophyte removal. The average age at surgery was 63 years. The thumb was involved in 4 patients, index finger in 1, middle finger in 7, ring finger in 4, and little finger in 3. Twelve patients had nail deformities associated with the mucous cyst. The average period of postoperative follow-up was 26 months. The dorsal half of the DIP joint capsule was resected with a punch and curette. The cyst and osteophytes were left intact. RESULTS The average preoperative range of motion for the DIP joint was from 10° of extension to 45° of flexion. Radiographs showed osteophytes at the DIP joint in all affected digits. After surgery, all cysts disappeared at an average of 3 weeks. There was no recurrence at the time of final follow-up. All nail deformities had resolved at an average of 5 months after surgery. The average motion for the DIP joint at the time of final follow-up was from 8° of extension to 56° of flexion. There were no acquired nail deformities or other complications. CONCLUSIONS A total dorsal capsulectomy alone was a simple treatment for mucous cysts and did not lead to any recurrence. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Kohei Kanaya
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
| | - Takuro Wada
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Kousuke Iba
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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Lee HJ, Kim PT, Jeon IH, Kyung HS, Ra IH, Kim TK. Osteophyte excision without cyst excision for a mucous cyst of the finger. J Hand Surg Eur Vol 2014; 39:258-61. [PMID: 23468080 DOI: 10.1177/1753193413478549] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Osteophyte excision is a mainstay of treatment for mucous cyst combined with Heberden's node in a distal interphalangeal joint or in an interphalangeal joint of the thumb. The aim of this study was to evaluate the results of osteophyte excision without cyst excision for the treatment of a mucous cyst combined with Heberden's node. The medical records of 37 patients (42 cases) with a mucous cyst with Heberden's node were retrospectively reviewed. Thirty-eight of 40 cases with available pre-operative simple radiographs showed evidence of joint arthrosis. A T-shaped skin incision of the joint capsule between the extensor tendon and lateral collateral ligament was used. Osteophyte excision without cyst excision was performed. All cysts, except one, regressed without recurrence or a skin complication after osteophyte excision, but eight cases showed post-operative pain and loss of range of motion. Osteophyte excision without cyst excision may be a good treatment choice for mucous cyst of the finger.
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Affiliation(s)
- H-J Lee
- 1Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
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The Zitelli design for bilobed flap applied on skin defects after digital mucous cyst excision. A review of 9 cases. Tech Hand Up Extrem Surg 2012; 16:124-6. [PMID: 22913990 DOI: 10.1097/bth.0b013e3182560336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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.
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Abstract
Background: Digital mucous cyst (DMC) is a common benign condition, but consensus has not been reached regarding its pathogenesis and treatment. Objective: This review provides a concise overview of DMCs. Methods: The review presents the literature pertaining to the etiology, pathogenesis, classification, clinical features, epidemiology, differential diagnoses, diagnosis, and management of DMCs. Results: DMCs have a predilection for middle-aged patients, a good prognosis, and a high recurrence rate. DMCs may occur in one of three locations on the distal digit. They arise owing to a metaplastic or degenerative process. Preexisting osteoarthritis is common and may be an etiologic factor in patients with DMCs. A number of conservative and surgical treatments are available depending on the structures and locations involved. Conclusion: Studies with greater sample size and longer follow-up would enrich current knowledge of the benefits, recurrences, and complications for each treatment modality.
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Affiliation(s)
- Kayi Li
- From the Faculty of Medicine, University of Toronto, and The Dermatology Centre, Toronto, ON
| | - Benjamin Barankin
- From the Faculty of Medicine, University of Toronto, and The Dermatology Centre, Toronto, ON
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Affiliation(s)
- Jeffrey E Budoff
- Department of Orthopaedic Surgery, University of Texas, Houston, TX, USA.
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Hoshino Y, Saito N, Kuroda H. Surgical treatment of mucous cysts on fingers without skin excision. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2010; 15:145-148. [PMID: 20672407 DOI: 10.1142/s0218810410004692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 03/02/2010] [Accepted: 05/24/2010] [Indexed: 05/29/2023]
Abstract
Mucous cysts on the fingers are commonly treated by excision followed by a rotation flap or skin graft. However, such procedures require skin donors or large incisions. Therefore, a less invasive procedure is needed. Here, we report a surgical treatment method that does not require the excision of the cyst. A skin flap was made around the cyst and raised; the pedicle of the cyst was then electrodesiccated or ligated, and the contents of the cyst were evacuated. If the pedicle could not be clearly identified, the backside of the flap was electrodesiccated to break the connection between the cyst and the distal interphalangeal joint. The skin flap was replaced and sutured. The flaps became almost normal during the follow-up period. No complications or recurrences occurred in any of the six cases that were treated. Our procedure appears to be an effective and less-invasive treatment for mucous cysts of the fingers.
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Affiliation(s)
- Yuko Hoshino
- Department of Orthopedic Surgery, Kameda General Hospital, 929 Higashi-cho, Kamogawa City, Chiba 296-8602, Japan.
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Malignant Natural-Killer cell neoplasm presenting as a mucous cyst on the distal interphalangeal joint of the finger. Arch Orthop Trauma Surg 2009; 129:1613-6. [PMID: 19084980 DOI: 10.1007/s00402-008-0794-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2008] [Indexed: 10/21/2022]
Abstract
This case report describes a very rare and highly malignant type of lymphoma, which presents as a mucous cyst on the finger. The cyst was excised and the specimen pathohistologically analyzed. The analysis revealed the presence of a Natural-Killer cell neoplasm. This case illustrates and stresses the importance of a pathohistological examination when doubts arise about the initial diagnosis of a benign tumorous lesion.
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Jamnadas-Khoda B, Agarwal R, Harper R, Page RE. Use of Wolfe graft for the treatment of mucous cysts. J Hand Surg Eur Vol 2009; 34:519-21. [PMID: 19675033 DOI: 10.1177/1753193409103498] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Many surgical procedures have been described for the treatment of mucous cysts. We report a case series of a surgical technique that excises the cyst along with overlying skin and reconstructs the defect using a Wolfe graft harvested from the wrist crease. This technique can be applied to cysts in all locations, even those adjacent to the nail. The procedure has been performed on 51 mucous cysts with satisfactory results, a very low recurrence rate (4%) and negligible complications.
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Affiliation(s)
- B Jamnadas-Khoda
- Department of Plastic Surgery, Northern General Hospital, Sheffield, UK.
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Abstract
Degenerative joint disease affecting the thumb metacarpophalangeal and interphalangeal joints is a debilitating condition, which can significantly restrict activities of daily living. Conservative measures to address symptoms include oral anti-inflammatory medications, activity modification and splinting, and intraarticular corticosteroid injections. Surgical interventions include arthroscopic synovectomy, arthroplasty, and finally arthrodesis of the affected articulations. Although short-term results from synovectomy and arthroplasty seem promising, long-term data are not yet available. Arthrodesis of the metacarpophalangeal and interphalangeal joints yields a stable yet functional thumb with reliably good pain relief.
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Affiliation(s)
- Eon K Shin
- Thomas Jefferson University Hospital, The Philadelphia Hand Center, P.C., 834 Chestnut Street, Suite G114, Philadelphia, PA 19107, USA.
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Flap advancement coverage after excision of large mucous cysts. CURRENT ORTHOPAEDIC PRACTICE 2008. [DOI: 10.1097/bco.0b013e3283031dd2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Minami S, Nakagawa N, Ito T, Sadanobu N, Lin Y, Natsuaki M, Yamanishi K. A simple and effective technique for the cryotherapy of digital mucous cysts. Dermatol Surg 2007; 33:1280-2. [PMID: 17903165 DOI: 10.1111/j.1524-4725.2007.33267.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Shoichiro Minami
- Department of Dermatology, Hyogo College of Medicine, Hyogo, Japan.
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A Simple and Effective Technique for the Cryotherapy of Digital Mucous Cysts. Dermatol Surg 2007. [DOI: 10.1097/00042728-200710000-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Soft tissue tumors of the hand arise from skin, subcutaneous tissue, tendons, nerve, and blood vessels. Many of these lesions occur on other parts of the body; however, the hand remains a unique site because these tumors have symptoms, appearances, treatments, and prognoses that may be quite different than when on other parts of the body. Their characteristics and the severity of symptoms vary markedly depending on the exact location, size, and type of tumor-and many of these tumors can have multiple forms of presentation. Two articles are intended to provide an overview of benign (this article) and malignant tumors (subsequent issue) of the hand. The rarer and more deleterious tumors are discussed in detail while the common tumors and epidermal lesions with which practitioners are familiar are briefly overviewed. At the completion of these review articles, participants should be able to identify and diagnose various benign and malignant hand tumors as well as understand the accepted current treatment of these growths.
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Affiliation(s)
- Joseph F Sobanko
- Department of Dermatology, Georgetown University Hospital/Washington Hospital Center, Washington, DC 20010, USA.
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Abstract
Mucous cysts are common problems seen by hand surgeons. Surgical excision of symptomatic cysts is the most commonly accepted treatment. Removal of large mucous cysts often requires simultaneous flap coverage or skin grafting for the resulting defect. We present the use of a dorsal advancement flap to permit excellent skin coverage after cyst excision with a tension-free closure.
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Affiliation(s)
- Eon K Shin
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Affiliation(s)
- Todd P Stitik
- Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey 07103, USA
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Blanc S, Candelier G, Bonnan J, Faure P. [Use of a bilobed flap for the treatment of mucous cysts]. ACTA ACUST UNITED AC 2004; 23:137-41. [PMID: 15293919 DOI: 10.1016/j.main.2004.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In the case of mucous cysts with attenuated skin, the authors suggest radical excision of the cyst together with the overlying skin. The skin defect is repaired with a bilobed flap whose donor site is left to heal by secondary intention. This surgical procedure also allows exploration of other areas of mucoid degeneration and repair of the proximal nail fold when necessary. METHOD Twenty-six patients with an average age of 59 years (27 cysts), were operated with this procedure. Nail bed deformities were present in 55% of the cases. The cyst and the overlying skin were radically excised in conjunction with a dorsal capsulectomy; the use of the bilobed flap made the dissection easier, and flap translation allowed cover of the capsulectomy area and simultaneous repair of the nail fold in eight cases. RESULTS Patients were reviewed with an average follow-up of 13.7 months. Seventy percent of the patients had no pain, and in 85% of the cases there was no loss of motion. Cosmetic appearance was satisfactory, and nail bed deformities disappeared or clearly subsided in 86% of the cases. One patient developed recurrence. DISCUSSION Many surgical procedures have been described for mucous cysts treatment. This simple procedure allows radical excision of the cyst and the attenuated skin with low risk for the germinal matrix, precise location of cyst origin, repair of the nail fold and good skin cover in the capsulectomy area.
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Affiliation(s)
- S Blanc
- Urgences Mains Manche-Cotentin, centre hospitalier d'Avranches-Granville, rue des Menneries, 50406 Granville, France.
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Abstract
Most regard ganglion, giant cell tumor of tendon sheath and epidermal inclusion cysts as tumor-like conditions as opposed to true neoplasms. Ganglion cysts are the most common lesion of the hand and wrist, accounting for 50% to 70% of all masses identified. The majority of ganglion cysts can be treated nonoperatively but when surgery is performed a low recurrence rate can be anticipated. Giant cell tumor of the tendon sheath hand epidermoid cysts are also common hand lesions that require surgical excision in most instances. Of the three, giant cell tumor of tendon sheath have the most notable recurrence rates. This article reviews the clinical presentations of these lesions as well as their proposed pathophysiology.
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Affiliation(s)
- Mitchell E Nahra
- Lake Orthopaedic Associates, Inc., 9500 Mentor Avenue, Suite 210, Mentor, OH 44060, USA
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36
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Abstract
The outcome of surgically treated mucous cysts of the foot is poorly documented in the orthopaedic literature. This study reports on the treatment of mucous cysts of the toes by simple excision and joint debridement. This is in contrast to treatment of similar lesions in the fingers which is often treated by excision of the cyst, joint debridement, and rotational flap. Following this procedure on 15 patients (15 cysts), at a minimum of 2 years postoperatively, only one cyst had recurred at 9 months. All patients were satisfied by the cosmetic appearance of their toe. The authors reviewed the available literature on this condition and suggest that this method of treatment provides good functional and cosmetic results with a minimal rate of recurrence.
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Affiliation(s)
- James D F Calder
- Brisbane Foot and Ankle Centre, Level Nine, Arnold Janssen Centre, 259 Wickham Terrace, Brisbane, QLD 4000, Australia
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Rizzo M, Beckenbaugh RD. Treatment of mucous cysts of the fingers: review of 134 cases with minimum 2-year follow-up evaluation. J Hand Surg Am 2003; 28:519-24. [PMID: 12772114 DOI: 10.1053/jhsu.2003.50088] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the results of a single surgeon's treatment of mucoid cysts, comparing outcomes between injection and surgery. METHODS One hundred thirty-four cysts were treated, with a minimum 2-year follow-up period. Thirty-one patients had nail ridging or deformity at presentation. Eighty patients had multiple soft-tissue punctures into the cyst with a 25-gauge needle and injection with local anesthetic and steroid. Fifty-four patients had surgical excision and joint debridement. RESULTS In the injection group, complete resolution of the cyst occurred in 48 cases (60%). Among the 32 that recurred, repeat injections were performed in 8 cases; 3 resolved. No recurrences were noted in the surgery group. Nail ridging resolved after surgery in 25 digits; the remaining 6 digits had partial improvement or persistent ridging. Five infections occurred and were treated successfully with antibiotics (4) or debridement (1), or both. CONCLUSIONS Aspiration and injection was convenient but had a 40% recurrence rate. Surgery provided definitive treatment with no major long-term problems.
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Affiliation(s)
- Marco Rizzo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
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Young KA, Campbell AC. The bilobed flap in treatment of mucous cysts of the distal interphalangeal joint. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1999; 24:238-40. [PMID: 10372784 DOI: 10.1054/jhsb.1998.0191] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The bilobed flap has many uses in the field of plastic and reconstructive surgery. We describe its use in achieving skin cover following excision of mucous cysts in six digits in six patients, with a minimum follow up of 1 year. There were no postoperative complications. No cyst has recurred and cosmesis has been excellent in all cases.
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Affiliation(s)
- K A Young
- Department of Orthopaedic Surgery, Monklands Hospital, Airdrie, UK
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Fritz GR, Stern PJ, Dickey M. Complications following mucous cyst excision. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1997; 22:222-5. [PMID: 9149992 DOI: 10.1016/s0266-7681(97)80067-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Eighty-six mucous cysts in 79 patients were surgically excised. Follow-up was carried out at an average of 2.6 years. Fifteen digits (17%) had a residual loss of extension of 5 to 20 degrees at the IP or DIP joints. One patient developed a superficial infection and two developed a DIP pyarthrosis, which eventually required DIP arthrodesis. Nail deformities were present in 25 of 86 digits preoperatively (29%), 15 of which resolved after surgery (60%). Four of 61 digits developed a nail deformity which was not present preoperatively (7%). Three of 86 digits (3%) developed recurrence. Other complications included persistent swelling, pain, numbness, stiffness, and radial or ulnar deviation at the DIP joint. We recommend that patients be informed preoperatively of the potential risks of decreased range of motion, persistent swelling and pain, infection, recurrence, and persistent or postoperatively acquired nail deformity.
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Affiliation(s)
- G R Fritz
- Cincinnati Hand Surgery Consultants, Ohio, USA
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40
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Chaise F, Gaisne E, Friol JP, Bellemère P. [Mucoid cysts of the distal interphalangeal joints of the fingers. Apropos of a prospective series (100 cases)]. ANNALES DE CHIRURGIE DE LA MAIN ET DU MEMBRE SUPERIEUR : ORGANE OFFICIEL DES SOCIETES DE CHIRURGIE DE LA MAIN = ANNALS OF HAND AND UPPER LIMB SURGERY 1994; 13:184-9. [PMID: 7524586 DOI: 10.1016/s0753-9053(94)80045-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
100 mucous cysts of distal interphalangeal joint were treated by a radical excision that involved skin, cyst and dorsal capsular structures. The follow up was 2 years minimum, only two recurrence were noted, with other procedure the tate of recurrence is higher (10 to 20%). The proposed procedure is based on two hypothegenesis: skin localisation of mucous jelly, and degeneration of dorsal capsular structure of an arthritic joint.
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Affiliation(s)
- F Chaise
- Département de Chirurgie de la Main et des Nerfs périphériques, Clinique Mutualiste de Loire-Atlantique, Nantes
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Crawford RJ, Gupta A, Risitano G, Burke FD. Mucous cyst of the distal interphalangeal joint: treatment by simple excision or excision and rotation flap. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1990; 15:113-4. [PMID: 2307870 DOI: 10.1016/0266-7681_90_90064-b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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.
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Affiliation(s)
- R J Crawford
- Department of Hand Surgery, Derby Royal Infirmary
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