| Objective:Most patients have skin defects after digital mucous cyst excision,and this study aimed to assess the clinical outcomes of bipedicle advancement flap to cover the defect.Methods:According to the inclusion and exclusion criteria,collecting cases of digital mucous cysts treated with cyst resection with osteophyte and a bipedicle advancement flap to cover the defect resulting from cyst excision in Affiliated Zhongshan Hospital of Dalian University from January 2014 to January 2018.A total of 24 patients were included in the study.There were 9 males and 15 females,aged 45-79 years old,with an average of 64 years old.Four cysts affected the interphalangeal joint of the thumb,8 the distal interphalangeal joint of the index finger,6 the joint of the middle finger,5 the joint of the ring finger,and 1 the joint of little finger.Eighteen cysts affected dominant hand,with 6 affecting non-dominant hand.Three patients had a history of 2 type diabetes,and two patients had a history of hypertension.Four cases had a history of digital mucous cysts ruptured.Two cases had a history of previous liquid nitrogen cryosurgery.The size of the cyst is 8~15 mm with mean of 12 mm,and the range of motion of the distal interphalangeal joint or thumb interphalangeal joint is69°±12°.Preoperative X-ray film of affected hand was made in all cases.The surgery was performed under a digital nerve block.A digital tourniquet was applied.The location of the skin incision depended on the position of the cyst.A transverse spindle-shaped incision was made surrounding the site of thin skin on the surface of the cyst,and the length of the incision exceeded that of the cyst.After the cyst was completely resected,a longitudinal incision was made in the joint capsule using the preoperative X-ray findings and palpation to locate the position of the osteophyte which was completely removed with a rongeur.The extent of the osteophytectomy did not exceed the edge of the normal articular cartilage.The joint capsule was sutured tightly.At the proximal side of the defect,a new incision with a similar length and arc to the proximal edge of the incisional defect was made.The distance between the two incisions was at least half the length of the proximal edge of the incisional defect.The new incision extended along the surface of the extensor tendon.The tissue was separated from the surface of the tendon,and then a flap with two pedicles was created.The flap was pulled to the distal end to allow the defect to be sutured with little to no tension.The proximal edge of the new incision was also separated along the proximal side of the surface of the tendon surface and pulled to the distal side,and then the new incision was sutured.The postoperative cyst recurrence was recorded.The range of motion of the distal interphalangeal joint or thumb interphalangeal joint were measured preoperatively and 6 months after surgery.The paired t-test was used to compare preand post-operative of the range of motion of the joint.Statistical significance was accepted for probabilities of < 5%(p < 0.05).Result:All patients were followed up for 8 to 48 months with average follow-up of 25 months.In period of follow-up,all the flaps survived,the incisions healed well without infection,and no cyst recurrence occurred.The range of motion of the joint of 6 month after surgery were 72°?10°.There was no difference between preoperative and postoperative range of motion of the joint(P=0.075).Conclusion:1.Digital mucous cysts excision with osteophyte is an effective treatment for digital mucous cysts.2.The bipedicle advancement flap may be a simple and effective technique for covering defects resulting from digital mucous cysts excision. |
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