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Kawakatsu M. Use of a Dorsal Digital Perforator Flap after Total Cyst Resection, Osteophyte Resection, and Synovia Intraarticular Curettage in the Treatment of a Large Mucous Cyst. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5945. [PMID: 38957714 PMCID: PMC11216670 DOI: 10.1097/gox.0000000000005945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/14/2024] [Indexed: 07/04/2024]
Affiliation(s)
- Motohisa Kawakatsu
- From the Department of Plastic and Reconstructive Surgery, Sumiya Orthopaedic Hospital, Wakayama, Japan
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Laulan J, Chammas M. Digital mucous cyst. HAND SURGERY & REHABILITATION 2024; 43S:101655. [PMID: 38879230 DOI: 10.1016/j.hansur.2024.101655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/24/2024] [Indexed: 08/23/2024]
Abstract
Mucous cyst is a benign but recurrent lesion. It is located on the dorsal surface of the digital extremity between the distal interphalangeal joint and the base of the nail. The nail is often affected by the cyst because of its topographical proximity. Nail plate deformity may even be the first obvious abnormality indicating the presence of a small mucous cyst or subungual cyst. Mucous cyst is associated with osteoarthritis of the joint, osteophytes probably being the main contributing factor. Surgical treatment by joint debridement and cyst removal is the most effective way of preventing recurrence.
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Affiliation(s)
- Jacky Laulan
- Service de Chirurgie de la Main, des Nerfs Périphériques, Hôpital Trousseau, CHU de Tours, France
| | - Michel Chammas
- Service de Chirurgie de la Main, Membre Supérieur, SOS Main, Hôpital Lapeyronie, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier cedex 5, France.
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Sano K, Kimura K, Ichikawa Y, Mizuno H. Blind Curettage Technique for Treatment of Mucous Cysts Associated with Heberden Nodes: Description of Operative Technique. J Hand Microsurg 2024; 16:100023. [PMID: 38854384 PMCID: PMC11127517 DOI: 10.1055/s-0043-1761228] [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: 03/14/2023] Open
Abstract
The standard treatment for mucous cysts with Heberden nodes is excision of the dorsolateral osteophytes and capsule of the distal interphalangeal joint or thumb interphalangeal joint, including the stalk of the cyst. The skin incision varies for cases depending upon the geometry. We propose a surgical method utilizing blind lateral approaches for treating such mucous cysts.
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Affiliation(s)
- Kazufumi Sano
- Department of Plastic & Reconstructive Surgery, Juntendo University Hospital, 3-1-3 Hongo Bunkyoku, Tokyo, Japan
- Division of Orthopedic Surgery, Koshigaya Seiwa Hospital, 4-25-5 Yanaka-cho Koshigaya, Saitama, Japan
| | - Kazumasa Kimura
- Division of Orthopedic Surgery, Koshigaya Seiwa Hospital, 4-25-5 Yanaka-cho Koshigaya, Saitama, Japan
- Department of Orthopedic Surgery, Dokkyo Saitama Medical Center, 2-1-50 Minami-koshigaya Koshigaya, Saitama, Japan
| | - Yuichi Ichikawa
- Department of Plastic & Reconstructive Surgery, Juntendo University Hospital, 3-1-3 Hongo Bunkyoku, Tokyo, Japan
| | - Hiroshi Mizuno
- Department of Plastic & Reconstructive Surgery, Juntendo University Hospital, 3-1-3 Hongo Bunkyoku, Tokyo, Japan
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Houghton ER, Moulton LS, Keogh A. The anatomy of the extensor tendon insertion in the arthritic distal interphalangeal joint: a cadaveric study. J Hand Surg Eur Vol 2024; 49:272-274. [PMID: 37747739 DOI: 10.1177/17531934231201956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Dissection of arthritic cadaveric digits revealed an expanded extensor tendon footprint involving the dorsal osteophyte on the terminal phalanx. Osteophyte attachments can be safely released up to the width of a number 15 scalpel blade without risking the integrity of the extensor tendon.
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Affiliation(s)
- Eleanor Ruth Houghton
- Department of Orthopaedic Surgery, Fremantle Hospital, South Metropolitan Health Service, Fremantle, WA, Australia
| | - Lawrence Stephen Moulton
- Department of Trauma and Orthopaedics, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, Cornwall, UK
| | - Angus Keogh
- Perth Upper Limb Surgery, St John of God Hospital, Subiaco, WA, Australia and CTEC (Clinical Training and Evaluation Centre), University of Western Australia, Crawley, WA, Australia
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5
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Ganglions in the Hand and Wrist: Advances in 2 Decades. J Am Acad Orthop Surg 2023; 31:e58-e67. [PMID: 36580047 DOI: 10.5435/jaaos-d-22-00105] [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: 01/27/2022] [Accepted: 10/12/2022] [Indexed: 12/30/2022] Open
Abstract
Ganglion cysts represent the most common soft-tissue mass in the hand and wrist. Ganglion cysts are most commonly encountered at the dorsal or volar aspects of the wrist, although cysts may arise from the flexor tendon sheath, interphalangeal joint, and extensor tendons. Intraosseous and intraneural ganglion cysts have also been described. Diagnosis of ganglion cysts relies primarily on history and physical examination. Transillumination and aspiration of masses may be useful adjuncts to diagnosis. Imaging such as radiography and ultrasonography may be indicated to evaluate for associated conditions, such as degenerative joint disease, or to rule out a solid or heterogeneous mass. Advanced imaging such as MRI is generally reserved for patients in whom occult ganglions, intraosseous ganglions, or solid tumors, including sarcoma, remain a concern. Treatment of ganglion cysts includes observation, aspiration or puncture with possible corticosteroid injection, and surgical excision. Nonsurgical management may result in cyst resolution in over 50% of patients. Surgical excision is associated with recurrence rates of 7% to 39%. Advances in surgical techniques have allowed surgeons to conduct arthroscopic ganglion excision, with recurrence rates similar to those of open management. This study highlights the advances in diagnosis, treatment, and outcomes that have taken place over the past 2 decades for this common condition affecting the hand and wrist in the adult population.
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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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Ma YM, Meng XJ, Su Y, Yan ZF, Shao QS, Chen YQ. Bipedicle Advancement Flap for Skin Coverage after Digital Mucous Cyst Excision: A Retrospective Study of 18 Cases. Orthop Surg 2020; 13:196-201. [PMID: 33283444 PMCID: PMC7862165 DOI: 10.1111/os.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/12/2020] [Accepted: 10/18/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives To assess the clinical outcomes of using a bipedicle advancement flap to cover the skin defects after digital mucous cyst (DMC) excision. Methods Data for 15 patients (18 fingers) with DMC, admitted to the Department of Orthopaedics and Surgery of the Affiliated Zhongshan Hospital of Dalian University from January 2016 to January 2018, were analyzed retrospectively. This study included 4 men and 11 women, with a mean age of 64 ± 7.8 years (range, 47–77 years). A total of 5 cases involved the thumb, 4 involved the index finger, 5 involved ithe middle finger, and 4 involved the ring finger. Among a total of 18 digital mucous cysts, 7 cases were in the left hand and 11 were in the right hand. Approximately 77.8% of cases had osteophytes. The cysts ranged in size from 0.5–1.0 cm to 0.7–1.2 cm. All patients underwent cyst and osteophyte excision and a bipedicle advancement flap to cover the resultant defect. The same surgical procedure was applied to all patients. Postoperative flap survival, healing, and infection were evaluated. The preoperative and postoperative ranges of motion (ROM) of the distal interphalangeal (DIP) and thumb interphalangeal joints (TIPJ) were recorded. Postoperative patient satisfaction was assessed by the visual analog scale (VAS, 0–10) during follow‐up visits. The Shapiro–Wilk test was used to determine whether the data for the difference between the preoperative and postoperative ROM of the DIP/TIPJ were normally distributed or not. The homogeneity of variance was expressed as mean ± standard deviation. A paired t‐test was used to compare the preoperative and postoperative ROM of the DIP/TIPJ. Results The patients were followed up for 20 ± 6.0 months (range, 12–36 months). All the flaps survived after surgery, and the incisions healed well. The sutures were removed 2 weeks postoperatively. No infections occurred and there was no cyst recurrence at follow up. After systemic physical therapy and functional exercises, the ROM of all the fingers was restored to the preoperative ROM by 1 month after surgery. The scores for patient satisfaction with surgery by means of the VAS were 8.5 ± 1.0 points, 2.8 ± 1.4 points, 2.0 ± 1.6 points, 1.5 ± 1.2 points, and 1.1 ± 1.3 points preoperatively, and 1, 3, 6, and 12 months postoperatively, respectively. The data for the difference between preoperative and postoperative VAS scores were normally distributed. There were significant differences between the preoperative and postoperative VAS scores. The preoperative DIP/TIPJ ROM was 71.7° ± 14.0°, and the postoperative ROM at 1, 3, 6, and 12 months were 69.3° ± 15.3°, 70.4° ± 12.7°, 71.5° ± 15.6°, and 71.8° ± 15.6°, respectively. The data for the difference between preoperative and postoperative ROM of the DIP/TIPJ were normally distributed. No difference was found between the preoperative and postoperative ROM. Conclusion The bipedicle advancement flap provides a simple and effective technique for covering skin defects following DMC excision.
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Affiliation(s)
- Yan-Ming Ma
- Department of Orthopaedics, Affiliated Zhongshan Hospital, Dalian University, Liaoning, China
| | - Xiang-Jun Meng
- Department of Ophthalmology, Affiliated Zhongshan Hospital, Dalian University, Liaoning, China
| | - Yun Su
- Department of Orthopaedics, Affiliated Zhongshan Hospital, Dalian University, Liaoning, China
| | - Zuo-Fa Yan
- Department of Orthopaedics, Affiliated Zhongshan Hospital, Dalian University, Liaoning, China
| | - Quan-Sheng Shao
- Department of Orthopaedics, Affiliated Zhongshan Hospital, Dalian University, Liaoning, China
| | - Yi-Qing Chen
- Department of Orthopaedics, Affiliated Zhongshan Hospital, Dalian University, Liaoning, China
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Hsiung W, Huang HK, Chen TM, Chang MC, Wang JP. The outcome of minimally invasive surgery for digital mucous cyst: a 2-year follow-up of percutaneous capsulotomy. J DERMATOL TREAT 2020; 33:449-455. [PMID: 32432965 DOI: 10.1080/09546634.2020.1769016] [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: 10/24/2022]
Abstract
Background: Digital mucous cyst(DMC) is the most common tumor or cyst of the hand. Although many operative methods have been proposed to treat DMCs and lower the recurrence rate, many patients hesitate to have surgery. A minimally invasive treatment using percutaneous capsulotomy for the DMCs could be an alternative choice. However, the clinical results of using this method are still uncertain.Objectives: Here, we introduce the percutaneous capsulotomy method and assess the clinical outcomes and the associated complications of this method. Methods: A total of 42 digits were finally included. All patients accepted percutaneous capsulotomy under a digital ring block. Functional and radiographic assessments were made pre- and postoperatively, with a mean of 28.8 months (range, 24-33 months) of follow-up. Results: The mean duration of the appearance of DMCs before treatment was 11.6 months. Of the 19 digits with nail deformity, 14 showed an improved nail appearance. There were no skin complications. The average visual analogue scale (VAS) satisfaction score was 9.4, only two cases had experienced recurrence at the final follow up. Conclusions: This study reported that percutaneous capsulotomy could be an effective method for DMCs treatment. The recurrence rate was low and patient satisfaction was good. Nail deformities could be improved with treatment.
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Affiliation(s)
- Wei Hsiung
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hui-Kuang Huang
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics, Chiayi Christian Hospital, Chiayi, Taiwan.,Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Tung-Ming Chen
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Taipei City Hospital-ZhongXiao Branch, Taipei, Taiwan
| | - Ming-Chau Chang
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jung-Pan Wang
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
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Abstract
The distal interphalangeal (DIP) joints are subjected to the highest joint forces in the hand, and at least 60% of individuals older than age 60 years have DIP joint arthritis. Debridement of degenerative distal interphalangeal joints with mild to moderate disease can provide satisfactory outcomes; however, those joints with more severe angular and rotation changes are reliably treated with fusions. Regardless of the fixation method, DIP fusions have high success rates, are well tolerated, and are extremely durable.
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10
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Lin EA, Papatheodorou LK, Sotereanos DG. Cheilectomy for Treatment of Symptomatic Distal Interphalangeal Joint Osteoarthritis: A Review of 78 Patients. J Hand Surg Am 2017; 42:889-893. [PMID: 28802534 DOI: 10.1016/j.jhsa.2017.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 06/21/2017] [Accepted: 07/10/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether open cheilectomy and debridement of the distal interphalangeal (DIP) joint is a safe and effective alternative to joint arthrodesis for the treatment of symptomatic osteoarthritis. METHODS Seventy-eight patients with symptomatic DIP joint osteoarthritis and with a minimum follow-up of 24 months were retrospectively reviewed. Preoperative radiographs were graded. Open cheilectomy and debridement of the DIP joint was performed in all patients. The DIP joint was immobilized for 4 weeks after surgery. Patients were evaluated clinically and radiographically. Visual analog scale pain scores and range of motion were assessed. RESULTS At a median final follow-up of 36 months (minimum, 24 months), there was a significant improvement in mean visual analog scale pain scores from 8 to 1. Distal interphalangeal joint flexion contracture was improved by a mean of 6° and DIP joint range of motion was improved by a mean of 20°. No postoperative infections or other complication were noted. No reoperations were required/performed during the follow-up period. CONCLUSIONS Open DIP joint cheilectomy is a safe and effective alternative to DIP joint arthrodesis in patients with symptomatic osteoarthritis who wish to preserve joint motion. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Edward A Lin
- Department of Orthopaedic Surgery, University of Pittsburgh, Orthopaedic Specialists-UPMC, Pittsburgh, PA
| | - Loukia K Papatheodorou
- Department of Orthopaedic Surgery, University of Pittsburgh, Orthopaedic Specialists-UPMC, Pittsburgh, PA
| | - Dean G Sotereanos
- Department of Orthopaedic Surgery, University of Pittsburgh, Orthopaedic Specialists-UPMC, Pittsburgh, PA.
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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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Kim EJ, Huh JW, Park HJ. Digital Mucous Cyst: A Clinical-Surgical Study. Ann Dermatol 2017; 29:69-73. [PMID: 28223749 PMCID: PMC5318530 DOI: 10.5021/ad.2017.29.1.69] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 04/12/2016] [Accepted: 06/17/2016] [Indexed: 12/28/2022] Open
Abstract
Background It has been suggested digital mucous cysts (DMCs) are associated with osteoarthritis and osteophytes in the elderly, and usually have a communicating pedicle with the joint. Surgical excision is a standard therapy with a high cure rate. Objective The purpose of this prospective study is to evaluate the features of DMCs via clinical, radiological and pathological examination and the efficacy of surgical excision of DMCs. Methods Between 2010 and 2014, 24 Korean patients were treated with the resection of the cyst and the pedicle. Preoperative X-ray and ultrasonography were performed to detect the presence of the osteophyte and the connection to the joint space. Postoperative patients' satisfaction score was assessed by the visual analogue scale (0~10). Results The osteophytes were found in 15.8%. In ultrasonographic findings, there were prominent flow signals between the cyst and the joint space in 13.6%. There were no serious postoperative complications, and recurrences were observed in 16.7%. Mean postoperative satisfaction score was 8.3. Conclusion It seems that preoperative X-ray for osteophytes and ultrasonographic study for connection are not always helpful for the treatment of DMCs, and that the surgical excision with a pedicle ligation and electrocoagulation is an effective treatment modality.
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Affiliation(s)
- Eun Jung Kim
- Department of Dermatology, Wonkwang University School of Medicine, Iksan, Korea
| | - Joon Won Huh
- Department of Dermatology, VHS Medical Center, Seoul, Korea
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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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