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Management of Digital Myxoid Cysts
A simple, new procedure effectively treated cysts on the fingers without excision of skin.
Digital myxoid cysts (DMCs) can be effectively treated once the connection between the DMC and the distal interphalangeal joint (DIPJ) is identified. The current approach is to inject methylene blue dye to delineate the connection between the joint and the cyst and then dissect and excise the whole system. The procedure is relatively involved and time consuming. The author of this prospective, open, nonrandomized case series evaluated a simpler approach in patients with symptomatic DMCs (26 finger, 6 toe). The cysts were treated by elevating a proximally based, arcuate flap below the level of the cyst and extending to the DIPJ capsule. The DMC was excised from the undersurface of the flap. No skin was excised, and the flap was repositioned and sutured in place with a single layer of sutures.
After a minimum follow-up of 8 months (mean, 18 months), 24 (92%) of the 26 finger DMCs and 2 (33%) of the toe DMCs remained healed without recurrence. Nail dystrophy induced by overlying pressure from the DMC had been present in 65% of patients and resolved after treatment in all. One episode of postoperative bleeding and one case of infection occurred. Pain lasting up to 1 month developed in two patients, and in one patient, pain was present at the final 8-month follow-up. One patient had decreased mobility in the affected finger lasting 1 month.
Comment: Just raising a simple skin flap under a digital myxoid cyst appears to be a very effective treatment for finger DMCs. The proposed mechanism of action is the formation of a fibrous plate in the undermined area between the DMC and the joint space. This simple procedure should bring the treatment of finger DMCs back into the dermatologist’s office from the hand surgeon’s office, where many of these patients are now referred. Toe DMCs still await the development of an effective treatment modality.
— George J. Hruza, MD
Published in Journal Watch Dermatology January 17, 2006
Citation(s):
Lawrence C. Skin excision and osteophyte removal is not required in the surgical treatment of digital myxoid cysts. Arch Dermatol 2005 Dec; 141:1560-4.
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