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Patankar AG, Avendano JP, Gencarelli P, Tawfik AM, Alter TH, Katt BM. Effects of Postoperative Splinting on Outcomes following Digital Mucous Cyst Excision: A Retrospective Review. J Hand Microsurg 2024; 16:100039. [PMID: 38855529 PMCID: PMC11144640 DOI: 10.1055/s-0043-1768583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Background Digital mucous cysts (DMCs) are masses on the fingers that can be definitively managed with surgical excision. Though uncommon, surgical site infections can develop into septic arthritis. We sought to determine whether postoperative splinting decreases rates of postoperative infection and the need for postoperative antibiotics. We also explored the effect of age, gender, obesity, and preoperative antibiotic administration on infectious complications. Methods Patients who underwent DMC excision between 2011 and 2021 were retrospectively identified. Chi-squared and Fisher's exact tests were used to analyze the complication rates including documented infection, postoperative antibiotic administration, mass recurrence, and return to operating room. Associations were analyzed between both preoperative antibiotic administration and postoperative splinting with respect to postsurgical complications. Results The database search identified 373 patients who underwent 394 DMC excisions. Postoperative antibiotics were given in splinted patients at lower rates than their nonsplinted counterparts with a small-to-moderate effect size, but the difference was not statistically significant (2.7 vs. 7.5%). Preoperative antibiotic administration was not found to significantly affect the prescription of postoperative antibiotics. Splinting did not reduce rates of DMC recurrence. Patients who were splinted were more likely to have also received preoperative antibiotics. Males were given postoperative antibiotics more frequently than females (12.6 vs. 4.0%). Conclusions Though not statistically significant, splinted patients were prescribed postoperative antibiotics less frequently. Postoperative antibiotics were utilized more frequently than the rate of infections typically reported following this procedure, possibly indicating overcautious prescription habits or underreported suspected infections.
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Affiliation(s)
- Aneesh G. Patankar
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - John P. Avendano
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Pasquale Gencarelli
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Amr M. Tawfik
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Todd H. Alter
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Brian M. Katt
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
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Kim YJ, Lee HM, Cho JH, Kim DH, Ahn HH, Seo SH. Efficacy of Bleomycin Intralesional Injection for Treating Digital Mucous Cysts: A Comparative Study of Corticosteroid Intralesional Injection and Surgical Excision. Ann Dermatol 2024; 36:180-185. [PMID: 38816979 PMCID: PMC11148311 DOI: 10.5021/ad.23.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Sclerotherapy has shown superior efficacy among the nonsurgical options for managing digital mucous cysts (DMC). Notably, previous research has indicated that bleomycin offers a more favorable side-effect profile and similar efficacy to conventional sclerosing agents. OBJECTIVE This study aimed to assess the efficacy and safety of bleomycin intralesional injection (ILI) for treating DMC through a comparative analysis of corticosteroid ILI and surgical excision. METHODS We retrospectively reviewed electronic medical records and clinical photographs. Telephone interviews were conducted to further investigate long-term treatment efficacy, safety, and overall treatment satisfaction. RESULTS Ten patients underwent surgical excision, and 13 and 15 patients received bleomycin and corticosteroid ILI, respectively. Both surgical excision and bleomycin ILI demonstrated superior treatment efficacy compared to corticosteroid ILI. No statistically significant difference in the treatment effectiveness between surgical excision and bleomycin ILI was observed. No significant adverse effects were observed. In the survey, the level of satisfaction was the highest for bleomycin ILI, followed by surgical excision and corticosteroid ILI. CONCLUSION This study revealed that bleomycin ILI exhibits a treatment efficacy higher than that of corticosteroid ILI and slightly lower than that of surgical excision, without any side effects. Therefore, bleomycin ILI is a safe and effective therapeutic option for the treatment of DMC.
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Affiliation(s)
- Yoon Jae Kim
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Hyun Mo Lee
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Jun Hyuk Cho
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Dai Hyun Kim
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Hyo Hyun Ahn
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Soo Hong Seo
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea.
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Fan Z, Chang L, Su X, Yang B, Zhu Z. Treatment of Mucous Cyst of the Distal Interphalangeal Joint With Osteophyte Excision and Joint Debridement. Front Surg 2022; 8:767098. [PMID: 35145989 PMCID: PMC8821517 DOI: 10.3389/fsurg.2021.767098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background Mucous cyst of the distal interphalangeal joint (DMC) or interphalangeal connection of the thumb is common in middle-aged and elderly people, and it often occurs in the fingers of people with osteoarthritis (OA). Although there are many conservative treatments, DMC is usually treated by surgery. The common complications of surgical treatment are recurrence of DMC and skin necrosis. This article introduces the method and clinical effect of osteophyte excision and joint debridement in the treatment of DMC of the distal interphalangeal (DIP) joint. Methods In total, 19 cases of affected fingers made an 'S' incision in the DIP joint under local anesthesia to remove the osteophyte of the DIP joint, clean the dorsal joint capsule, wash the joint, and retain only the bilateral collateral ligament and extensor tendon device. It is suspected that the injured finger of the extensor tendon should be protected by external fixation. Results Out of 15 patients, 1 patient presented with partial skin necrosis that healed after dressing changes while the other patients recovered well. The visual analog scale (VAS) scores of all affected fingers after surgery were lower than those before the surgery (VAS score: 4.93 ± 0.88 vs. 4.07 ± 1.03, p < 0.05). The range of motion (ROM) of the affected finger decreased in one patient, and the post-operative activity of the other fingers increased in varying degrees (ROM: 67.60 ± 5.40 vs. 71.27 ± 7.06, p > 0.05). Conclusions Using osteophyte excision and joint debridement to treat DMC can avoid skin necrosis caused by cyst removal and can avoid the recurrence of DMC to the greatest extent, so it is a safe and effective way of treatment.
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Affiliation(s)
- Zhiyi Fan
- Department of Hand Surgery, The Second Hospital of the Jilin University, Changchun, Jilin, China
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Li Chang
- Department of Pathology, The Second Hospital of Jilin University, Jilin, China
| | - Xing Su
- Department of Thrombosis and Hemostatic, State Key Laboratory of Experimental Hematology, Tianjin Clinical Research Center of Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Binbin Yang
- Office of Academic Research, Wenzhou Medical University, Wenzhou, China
| | - Zhe Zhu
- Department of Hand Surgery, The Second Hospital of the Jilin University, Changchun, Jilin, China
- *Correspondence: Zhe Zhu
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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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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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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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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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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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10
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Nugent NF, Cronin KJ. Dorsal digital ganglia excision with the use of a local transposition flap. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-011-0655-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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11
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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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12
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Affiliation(s)
- Jeffrey E Budoff
- Department of Orthopaedic Surgery, University of Texas, Houston, TX, USA.
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13
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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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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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